If the dose of alcohol be larger, these phenomena of stimulation are more pronounced, but very soon give place to depression, which spreads, like the excitement, from the highest to the lowest centres of the brain and cord. The intellectual, emotional, and voluntary faculties become first inco-ordinated, then dull, and finally completely arrested; the muscles are first ataxic and next paralysed, so that after an unsteady, staggering gait, the erect posture is impossible; and the consequent depression of the respiratory and circulatory centres leads to stertorous breathing, circulatory failure, and even death. The effects of alcohol upon the nervous centres are referable partly to dilatation of the blood-vessels of the brain and cord, out certainly also to a direct action of the drug upon the nerve cells.

The action of alcohol on the other bodily functions is chiefly, if not entirely, indirect. Thus, the muscles are affected solely through the nervous centres and nerves. Respiration is first increased, then slowed and weakened, partly through the special centre, but manifestly also, to a great extent, through the muscles and the circulation. Death occurs partly by asphyxia. The bodily temperature is, on the whole, lowered by alcohol: (1) by increased circulation through the dilated peripheral vessels; (2) by increased perspiration; (3) by diminished metabolism; and (4) after large non-medicinal doses, by general depression. The sense of warmth is, on the contrary, increased by the flushing of the skin with blood, a condition which promotes bodily heat and comfort in a warm or moderately cool atmosphere, but causes rapid refrigeration, general vital depression, and even death, in low states of the external temperature.

4. Specific Uses

The uses to which the complex specific action of alcohol may be turned are many, and of great importance:

Alcohol is employed in fever, and other acute wasting diseases, such as delirium tremens, and acute mania. The indications in these conditions are to prevent or to make good the great waste of tissues associated with the disease; to sustain the heart and nervous system, which threaten to fail, as the frequent pulse and the delirium testify; and to promote the loss of heat, which is formed in excess, as indicated by the thermometer, the dry-brown tongue, the sleeplessness, and the general restlessness of the patient. We have seen that these ends are all fulfilled to a certain extent by alcohol. When the symptoms just mentioned appear, brandy or other form of spirit, and wines of the stronger varieties, are given in a definite amount per diem, according to the height of the fever, the state of the pulse and heart sounds, the general strength, the ability to consume food, the previous habits, and the age of the patient. It must be distinctly understood, however, that alcohol is by no means essential in every case of fever; the very opposite being the case. In delirium tremens (acute alcoholism), where food, in the ordinary sense of the word, can often be given only with the greatest difficulty, the very substance which, as a stimulant, has caused the disease, must be judiciously continued as a form of nourishment for a time.

In chronic diseases attended by great debility, want of appetite, and.possibly sickness, such as pulmonary phthisis, alcohol will also find its place as a true food.

As a stimulant the principal use of alcohol is in connection with the heart. This, as we have just seen, is an important part of its action in fever. Of all remedies in threatening death by cardiac failure (syncope, fainting), spirits are the best, being at once available, convenient, rapid in their action, and almost invariably successful, if recovery be possible. For this purpose, brandy, whisky, etc., should be given either pure or only slightly diluted, by the stomach, bowel, or even under the skin. Hardly less valuable is alcohol, given continuously in small regular doses, in chronic disease of the heart, when natural hypertrophy fails and dilatation ensues. Wine, rectified spirit, or various tinctures, may be given in such cases.

In nervous depression alcohol must be ordered with the greatest hesitation. In melancholia, or in despondency begotten by grief, anxiety, suspense, over-work, excess, and especially by indulgence in alcohol itself, this drug affords only too ready relief, as also in neuralgia, hysteria, and allied disorders and sleeplessness; and the recommendation of it by the practitioner is frequently abused, being employed as a pretext for continued intemperance. In such cases the best rule is to order a definite amount of some weak alcoholic drink, such as ale or claret, at meal times only; but even this recommendation is by no means always safe. Severe pain, such as neuralgia, is often successfully relieved on the same principle. Some forms of sleeplessness are readily overcome by warm alcoholic draughts at bed-time, or malt liquors; but here again great discrimination is requisite in ordering the remedy.

6. Remote Local Action' And Uses

Alcohol given in medicinal doses is, as we have seen, almost entirely oxydised in the system, only 16 percent. passing out unchanged, chiefly by the lungs, less by the kidneys, and least by the skin. This amount, however, includes ethereal and other complex bodies associated with alcohol in wines and spirits; and by far the greater part of the alcohol proper is excreted as carbonic acid and water.

The diuretic effects of spirits, wines, and especially gin and beer, are well known, and may sometimes be employed in medicine. The diaphoretic effect of alcohol and its applications have been already sufficiently discussed under fever.

Circumstances modifying the action and employment of alcohol. - The different alcoholic fluids act very differently, according to their strength; their other constituents, already enumerated; the presence of carbonic acid in them (sparkling drinks), which increases the rapidity of their action on the stomach and possibly of their absorption; the degree to which they are diluted with water; and the condition of the stomach as regards the presence of food. The age of the patient, the soundness of his kidneys and other eliminating organs, his habits as regards alcohol, and the amount of exercise which he can take, must also be carefully estimated in ordering the remedy. In conditions of waste and exhaustion, especially febrile states and after operations, large quantities (even 1 pint of brandy per diem) may sometimes be tolerated.

Alcohol Amylicum. Amylic Alcohol.

"Fousel Oil," C5H12O, with a small proportion of other spirituous substances.

Source. - Contained in the crude spirit produced by the fermentation of saccharine solutions with yeast, and separated in the rectification of such spirit.

Characters. - A colourless oily liquid, with a penetrating and oppressive odour, and burning taste; specific gravity, .818. Boils at 270°. Sparingly soluble in water; freely in spirit and ether.

Impurities. - Other aethereal substances; detected by specific gravity and boiling point.

Preparation. Sodae Valerianas. - See Valeriana Radix, page 272.

Use

Amylic alcohol is used only to prepare Valerianate of Soda.