This section is from the book "A Text-Book Of Pharmacology, Therapeutics And Materia Medica", by T. Lauder Brunton. Also available from Amazon: A text-book of pharmacology, therapeutics and materia medica.
When those accustomed to indulge freely in stimulants are attacked by acute disease, or when they receive injuries, or when, in consequence of a drinking bout, their stomachs are so deranged as to bring on loss of appetite and vomiting, and to lower their nutrition, they are liable to delirium tremens. So long as the drunkard is able to eat and digest his food, he is little liable to this disease. As a rule delirium comes on in from two to four lays after he has lost his appetite and begun to vomit. This lelirium is marked by a peculiar tremor of the tongue, as well ts of the limbs, and by delusions which are especially connected vith the sense of sight, the unfortunate patient imagining that the sees noxious animals crawling around him, or that he is
Hagued by demons, which are sometimes of a blue colour, from which the disease is popularly known as ' blue devils.' The tongue is moist, and covered with a thick white fur. There is loss of appetite and vomiting, which is often obstinate. The delirium is constant and active. It may become violent, and there is great restlessness and sleeplessness. It may gradually subside, and the patient recover his health, or a condition of mania may ensue. Patients sometimes die suddenly, without any warning symptoms.
The treatment of delirium tremens consists in keeping up the strength of the patient by a nutritive diet, and preserving him from exhaustion by combating the sleeplessness which would cause it. The vomiting, which is the chief obstacle to nutrition,, is often well combated by a combination of bismuth, magnesia, and hydrocyanic acid, to which small quantities of morphine may be added. Until the patient is able to retain food, he ought to be fed by nutritive enemata, while chloral may be administered for the sleeplessness. A combination of chloral with bromide of potassium is often very useful. Large doses of digitalis have been given in order to quiet the delirium, and sometimes with benefit; but this is a very dangerous treatment, and it seems not improbable that the reason why the enormous doses of such a powerful drug have produced so little effect has simply been that they have not been absorbed from the stomach, for I have seen a case in which food lay undigested and unabsorbed in the stomach for a period of four days, after which it was vomited.
Causes of Chronic Alcoholism. - The craving for stimulants which leads to chronic alcoholic poisoning may be acquired by the habit of drinking in society; but it is not seldom due to the practice of taking alcohol in order to relieve depression of spirits, bodily or mental weakness, or inability to work as long or as well as might be desired. In men, the depression of spirits and feeling of weakness may be due to unfavourable physical surroundings, close atmosphere, over-work, exhausting discharges, or mental worry. In women, it may not only be connected with any of these, but also with uterine derangement. The craving appears to be partly gastric and partly systemic, and it is to be-combated by the substitution for alcohol of other stimulants which will not have the same deleterious action. As a stimulant to the stomach, producing a sensation of warmth, tincture of capsicum is very useful, and aromatic spirit of ammonia stimulates both the stomach itself and the circulation and nervous system generally. A useful formula consists of 20 or 30 minims of aromatic spirit of ammonia, with 5 to 10 minims of tincture of capsicum, in two ounces of infusion of gentian or cascarilla. This draught, which amounts to an ordinary wineglass-full, should be taken when the craving is felt. In place of this draught a lemon may be sucked, or a glass of iced or cold water, or effervescing water, may be slowly sipped so as to get its stimulating action on the cerebral circulation (p. 193) and heart (p. 194). At the same time chalybeate tonics and strychnine may be given in order to increase the nutrition of the tissues generally. The liquid extract of red cinchona bark has been recommended in such cases, and no doubt this medicine, along with easily digested food, beef-tea, and warm nutritive drinks, such as hot cocoa, may prove a useful adjunct in the treatment of chronic alcoholism.
In some patients the tendency to drink appears to be epileptic in character. The person affected by it will remain sober for weeks or even months, and then be suddenly seized with the fit, begin to drink, and remain drunk for several days together, and, after the conclusion of the bout, will again remain sober for a long time. I have seen a case in which this species of intermittent drunkenness was brought on by a fall from a horse, and was associated with epilepsy. The fit began with an intense craving for drink, and after one or two days' drunkenness epilepsy came on. If the desire for drink was not gratified, the fit came on sooner after the craving began than it would otherwise have done, but it was not so violent. The treatment in these cases is bromide of potassium combined with tonics.
Uses. - The cold produced by the evaporation of alcohol when it is applied to the skin and rapidly dissipated by fanning or blowing upon it is useful in preventing syncope, in relieving headache, or in rousing from fainting or coma. For these purposes one of the most convenient forms of application is eau-de-cologne, and in cases of headache this may be used, diluted with equal parts of water, and applied by means of a thin handkerchief. The power of alcohol to harden the epidermis renders it a useful application in cases where we desire to hinder the formation of bed-sores or prevent the nipples from cracking. Brandy is the form most frequently employed for this purpose, as it stimulates the circulation when its evaporation is prevented, and especially when aided by friction. Alcohol, diluted simply, or in conjunction with one half per cent. carbolic or salicylic acid, is useful in relieving pruritus in erythema and other diseases; a similar lotion is also useful in alopecia furfuracea. In urticaria it is best combined with petroleum (v. p. 762). It has been used as a liniment in the form of brandy or spirit to sprained joints. A little brandy held in the mouth increases the secretion of saliva, and often relieves toothache. Alcohol is also a useful gargle in relaxed sore-throat, port wine being a form in which it is frequently applied for this purpose. It is also a useful astringent wash to the mouth in cases of profuse salivation. As in small doses it increases the secretion of gastric juice, it forms a useful addition to the meals of persons whose digestive powers are weak either in consequence of temporary exhaustion or from permanent debility, occurring in convalescence from acute disease, general malnutrition, or from old age. Some men, after being busily engaged all day, go home exhausted, and dine immediately on their arrival. The consequence of this is that their food remains undigested, and they suffer from weight of the stomach and drowsiness. This condition may generally be prevented in persons-below middle age, by simply making them rest for a while, so that the stomach, as well as the body generally, may recover from fatigue before the meal is taken; but in elderly individuals the addition of a little alcoholic stimulant may be necessary to ensure digestion. This use of alcohol was noticed in the Ashantee campaign, in which the effect of alcohol as a stimulant, compared with beef-tea, was carefully tested. It was found that when a ration of rum was served out the soldier at first marched more briskly, but after about three miles had been traversed the effect of it seemed to be worn off, and he then lagged more than before. If a second ration were then given its effect was less marked, and wore off sooner than that of the first. A ration of beef-tea, however, seemed to have as great a stimulating power as one of rum, and not to be followed by any secondary depression. At the end of the march a short rest during the cooking of the evening meal seemed sufficient to enable the younger men to eat and digest it without the aid of rum, which they did not desire; but the men who had passed middle age not only wanted their own share of the alcohol, but were glad to get that of their younger comrades also.