Sexuality

From depression of the cerebrum the sexual desires are under much less restraint than normal, and Havelock Ellis rightly says: "It is obvious that those who wish to cultivate a strict chastity of thought and feeling would do well to avoid alcohol altogether, or to use it in its lightest forms and in moderation." If much alcohol is taken, the sexual powers are impaired from depression of the spinal cord, though the animal desire may still be present. In chronic alcoholics sexuality is not infrequently abolished; indeed, atrophy of the testicles is frequent.

Hypnotic Action

Other things being equal, alcohol, taken without exhilarating company, tends to promote drowsiness and sleep. Hence the use of beer, ale, or the hot toddy at bedtime.

Stupor

If much alcohol is taken in a short time the intoxication (exhilaration) stage is followed by bodily inactivity, mental dulness, and inattention. There is also ataxia from loss of muscular sense, so that it is difficult to button one's coat or to walk in a straight line or to tell just where one's legs are. The gait is staggering, either because of the ataxia or from cerebellar depression, and the speech is thick. During the stages of intoxication and stupor there is some general anesthesia from depression of the sensory centers, so that the alcoholic may injure himself without pain, as when he burns his fingers with a cigar or falls and breaks a limb. There is also some muscular relaxation from depression of the reflexes, and this accounts for the noticeable escape from fractures in drunken falls. As with ether, the sensory centers are affected before the motor, and there may be early impairment of feeling in the hands and feet; but the loss of muscular control may not be noticed until the victim attempts to walk. After this stage the patient may pass into an anesthetic, stuporous sleep, with slow and perhaps stertorous breathing; and he may even go on to coma, collapse, and death. Previous to the employment of ether and chloroform as anesthetics, whisky in intoxicating quantities was frequently administered as a preliminary to major operations.

It is observed that when liquor is taken without exhilarating surroundings and company, as by an invalid in bed, the drowsy or quiet stage supervenes without much preliminary exhilaration.

Therapeutically, the only desired effect upon the cerebrum is the narcotic one of quieting the nervous system, as in fevers or emotional shock or insomnia.

Cerebellum

In the intoxication there is incoordination, as shown by staggering gait, inability to use the hands with dexterity, and mixed or incoherent speech. These things may, however, as mentioned above, be due to other depressions than that of the cerebellum.

Spinal Cord

The reflexes are depressed, and the tone of muscle and the response to external stimuli are much lessened.

Muscular relaxation has been spoken of. The bladder reflex may fail, so that urine accumulation distends the bladder. This may go on to a dangerous degree, and catheterization become necessary. The sexual powers fail.

Peripheral Nerves

There is some depression of the nerves and nerve-endings, including the nerves of muscular sense, though the main factor in the anesthesia is central depression. In the excessive and continued use of alcohol its affinity for the nerves is shown in the frequency with which it produces a neuritis.

To sum up the action of alcohol as a narcotic we might say that it produces practically the same stages as ether, but that the stages are modified by the much slower rate at which the narcosis is produced; and that as alcohol is usually taken by stomach, rather than by inhalation, any irritant effects manifest themselves upon the stomach and liver instead of upon the nose, throat, and bronchi.

The stages of alcohol narcosis are:

1. Stage of blunted perceptive and intellectual faculties.

2. Intoxication - a much prolonged stage.

3. Stupor - general dulness and inattention leading to stuporous sleep.

4. Coma (serious), leading to collapse and death.

The apparent stimulating effects of alcohol are dependent essentially upon the following factors:

1. The local irritation - this results in true reflex stimulation of the circulation, but of only short duration. The less the dilution, the greater is the reflex effect.

2. The feeling of warmth - due to general dilatation of the skin vessels.

3. The early narcotic effect of depression of the higher centers, with freedom of the imaginative and emotional, and increase of confidence in one's physical and mental powers.

4. The food value - which is a striking factor only in conditions of debility and exhaustion.

5. In company, the effect of increased sociability and exhilarating environment.