Toxicology

In susceptible people even a teaspoonful of a strongly alcoholic tincture is enough to flush the face and make the head feel light.

Acute Alcoholism is drunkenness, and we have already considered its cerebral manifestations. The inattention to what is going on, the maudlin intellect, the uncertain speech, the staggering gait, need no description. Alcoholics tend to be pugnacious, lacrymose, sleepy, morose, cheerful, or overpolite, according to their temperaments, or owing to some special action of the liquor. There is some anesthesia, so that the pain of an injury is not felt; and there is partial muscular relaxation, so that falls are less likely than usual to result in broken bones. This stage of intoxication persists for a long time, but eventually passes into that of stupor, i. e., deep sleep from which one can be awakened with difficulty. When aroused from this alcoholic stupor, the patient shows stupidity and lack of intelligence, incoherent speech, relaxed muscles, and incoordination, so that he will fall limp, or at least have difficulty in walking. On being left alone he relapses at once into the stuporous sleep. This state distinguishes alcoholism from morphine poisoning, in which the patient on being aroused shows reasonable intelligence, can speak distinctly and answer questions, and can be kept actively walking.

The stupor of alcoholics often verges closely on coma; but even at this stage it is characteristic of alcohol that pressure on the supra-orbital nerve results in wincing or will actually arouse the patient. In this respect alcoholic stupor or coma differs from that of uremia, diabetes, opium-poisoning, or cerebral injury, in which pressure on the supra-orbital nerve meets with no response. Following the onset of coma, the alcoholic may readily pass into collapse and die. Death is not infrequent also from a fracture of the skull received in a drunken fall, or from pneumonia brought on by exposure. Very large amounts of strong liquor may produce death from reflex shock, an ending which has frequently occurred from drinking large quantities quickly as the result of a bet.

Treatment

It is the usual plan to give plenty of fresh air and let the drunkard sleep it off. Occasionally, especially if he has smoked freely, the patient vomits and is much improved. In some cases it may be necessary to empty the stomach by lavage or apomorphine, or to catheterize the bladder. Caffeine and strychnine are antidotal. If the patient goes into collapse, the regular treatment for collapse is indicated.

After-Effects

The systemic after-effects resemble those of ether anesthesia; viz., coated tongue, bad taste in mouth, loss of appetite, nausea, retching, vomiting, constipation, headache (bursting head), great restlessness, mental depression (remorse or disgust with one's self), and lack of energy. There are regularly thirst and desire for more liquor. There may be paralysis of an arm (Sunday-morning paralysis), from the drunkard having lain upon the arm in such a way as to cause pressure upon the brachial plexus.

Treatment

As a rule, the usual morning distress may be treated effectively with aromatic spirits of ammonia, or a hot, bitter, and carminative mixture. This is known as a "pick-me-up" or "morning tonic." There can hardly be any objection to giving teaspoonful doses of an alcoholic tincture even though one is treating alcoholism. A good prescription might be:

Toxicology 60

Tinct. capsici................

........3 j (4 c.c.)

Tinct. lavandulae comp........

........Toxicology 61 ss (15 c.c.)

Spiritus ammoniae aromatici

q. s. adToxicology 62 ij (60 c.c.)

M. Et Sig

One teaspoonful in water every one or two hours.

This is to be followed by a light meal of oyster stew, poached egg on toast, or toast and tea. If the patient is very restless, bromides may be given by mouth or morphine hypodermatically. A dose of calomel tends to lessen the "bilious" feeling; and when there is distressing retching and nausea, lavage or a hypodermatic of an emetic dose of apomorphine, repeated, if necessary, will clean the stomach.