Preventives

Leonard Hill reports that in alcohol poisoning fatty infiltration of the liver is prevented by feeding glycogen-builders, i. e., carbohydrates. Dogs which on pure fat diet put on 25 per cent. of dry liver substance as fat, have this per cent. lowered to one-half or less by the feeding of glycogen-builders at the same time. Von Noorden noted that the percentage of fat in both heart and liver of starved dogs increases from alcohol in a few days, but that this effect is prevented by sugar. Similar though less marked protection of the liver has been reported from sodium bicarbonate.

Therapeutics

External

As antiseptic, as in cleansing surgeon's hands or skin of patient. As cooling lotion in headache or in itching or for bruises (eau de cologne, spirit of camphor, witch-hazel, or tincture of arnica). For rubbing the body of an invalid, 50 to 95 per cent. alcohol is very refreshing, and in fever is cooling. As anhidrotic in sweating of the hands and feet and in the night-sweats of tuberculosis. To harden the skin, as when bed-sores are threatened. In refractory trigeminal neuralgia, 15 minims (1 c.c.) may be injected into the nerve.

As a preventive of carbolic acid bums, alcohol is the best remedy. Its affinity for the phenol being greater than that of the tissues, it prevents penetration of the carbolic. When the carbolic is swallowed, alcohol is best given in the form of whisky, but it should be at once washed out; for though it lessens the local effect, it may increase the absorption of the carbolic and hence the systemic poisoning.

Alimentary Tract

For their effect on appetite and digestion alcoholic drinks may be employed in convalescence and debility, and in conditions of diminished gastric secretion; for their carminative action, in flatulence and colic; for their reflex stimulating effect, in faintness and fainting. For the carminative and reflex stimulating effect the fortified wines and distilled liquors are employed. Ice-cold brandy and champagne, especially the latter, because of the Co2 it contains, are employed in seasickness and other forms of intractable nausea and vomiting. Brandy is a favorite remedy in summer diarrhea.

For systemic effect whisky and brandy are mostly employed:

1. To prevent or check a cold after exposure.

2. To furnish food and stimulation in depressed conditions, and in convalescence from acute illness (milk-punch).

3. As a narcotic or sedative in states of nervousness, restlessness, or delirium; in the delirum of alcoholics it may be especially necessary.

4. As hypnotic in mild chronic forms of insomnia, as from mental work late at night or continued nervous strain (beer, ale, or whisky taken at bed-time).

5. In fever, as antipyretic, as food, and as narcotic to allay nervousness and restlessness and promote quiet and sleep, but it lowers resistance.

6. In Shock

In surgical shock it tends to diminish the already lowered blood-pressure (Crile); but in mild degrees of shock, where consciousness is not abolished, as in emotional shock or mild trauma, the condition may be improved both by the reflex stimulation of the surface irritant action and by the narcotic effect upon the excited mind.

The use of alcohol in medicine has become very much limited in recent years, and we no longer see a pneumonia patient deluged with one or two pints of whisky a day, or one with tuberculosis feeding on innumerable milk-punches. That its real value in many cases is due to its narcotic or sedative effect has not been fully appreciated.

Contraindications

Gastric ulcer, gastric hypersecretion, hy-perchlorhydria, intestinal autointoxication, cirrhosis of the liver, nephritis, cystitis, urethritis, chronic eczema, and gout. In diabetes the sweet wines and malt liquors are distinctly contraindi-cated, and it is open to question if even a dry wine should be allowed.

Where it is known that the patient has been an alcohol habitue, it is criminal to prescribe an alcoholic drink, and it is the duty of the physician to consider well before prescribing any medicine with a distinctly alcoholic or vinous flavor. In sickness it is equally imperative to use judgment before cutting off the alcohol from a drinker; it will not do, for example, to stop the whisky of a chronic drinker during an attack of pneumonia.