Methyl alcohol, wood naphtha, or wood alcohol, Ch3oh, is not employed as a remedy, but is of interest because of the number of cases of poisoning following its use. Its local and central actions are similar to those of ethyl alcohol, and it can produce a somewhat similar intoxication, though the onset is slower and the depression or narcotic condition more prolonged. But two striking differences are that it is not readily excreted and is not fully oxidized. Indeed, its products in the body are formic acid and formaldehyd, and it is thought that these substances, or perhaps acetone and other bodies always present in the commercial article, may account for its especially deleterious effects. These effects are of two kinds, viz., atrophy of the optic nerve, with permanent blindness, and depression of cardiac and voluntary muscle, resulting in death. Birch-Hirschfeld (1916) notes that the symptoms do not develop for several hours or days, and begin by nausea, vomiting, dizziness and headache, progressing rapidly to delirium and convulsions. The poisoning should be suspected when toxic gastro-intestinal symptoms occur with sudden severe disturbances in vision, with central scotoma, contraction of the field of vision, and optic neuritis. Krol reports a pronounced acidosis. Thompson says it is strongly hemolytic. The treatment consists of plenty of fresh air and copious alkali-water-therapy to promote elimination.

Buller and Wood collected 54 cases with blindness in the United States and Canada, some of which died, and since then a great many cases of either blindness or death have been reported. After one celebration on doctored whisky at Dorpat, Russia, 16 men and 1 woman died, and 3 men became blind. At Stryker's Farms, near New York, 25 died from drinking a cheap whisky made of methyl alcohol. In the Berlin municipal lodging-house, in the month of December, 1911, there were 89 deaths and 5 cases of total blindness due to wood alcohol in cheap spirits. There are many other instances of recent date.

These deaths have usually followed debauches with adulterated whisky. But many instances of blindness have come from the inhalation of fumes in its industrial use, and from hair-tonics, bay-rum, cologne-water, essence of ginger, and other pharmaceuticals in which wood alcohol has been substituted for grain alcohol. As small an amount as 0.2 per cent. in the inspired air may lead to poisoning (Loewy). Because of many cases in New York city, the Health Department has an ordinance forbidding the use of methyl alcohol in any preparation for internal or external human use.

Hypnotics .

A hypnotic is a remedy employed to induce or to maintain sleep. Leonard Hill summarizes as follows the facts which are known concerning sleep:

1. Respiration

(a) The number per minute remains unaltered; the movement becomes shallow and thoracic in type; (b) the amount of inspired air per minute is lessened by from one-half to two-thirds; (c) the output of Co2 is diminished by one-half to two-thirds.

2. Circulation

(a) The blood congests in the limbs; (b) the venous system is engorged; (c) the arterial pressure falls; (d) the pulse-rate diminishes; and (e) the velocity of blood-flow decreases.

3. Temperature

The temperature falls during the night. The production of heat is estimated to diminish by from one-half to two-thirds.

4. Nervous System

(a) The blood-flow through the brain is diminished; (b) the acidity of the cortex decreases; (c) the excitability of consciousness to external stimuli steadily decreases during the first one to two hours of sound sleep. After that period the excitability rapidly becomes almost as great as it is toward the end of sleep; and (d) consciousness alone seems to be abrogated during sleep. The nerves and the special senses continue to transmit impulses and produce reflex movements.

Verworn's Theory

Sleep, as pointed out by Verworn, is entirely different from narcosis. Sleep comes because of - (1) The lessened irritability, i. e., fatigue, of the cells of the cerebral cortex which results from work; and (2) the removal of external stimuli, as noise, lights, etc. Narcosis comes from direct and deliberate depression of the cells of the cerebral cortex. In sleep the cells recover from fatigue, regain their lost irritability, and are restored to their full capacity for work; in other words, sleep implies restitution. In narcosis, on the other hand, there is no restitution, and the cells lose their irritability and go through the stages of fatigue production. A narcotic is prone to be followed by sleep because it produces fatigue of the cells, and when a narcotic substance is given to produce sleep (i. e., sl hypnotic), it does so by depressing the cells and thus reducing the excitability of the cerebral cortex which is preventing sleep. The depression of the cells thus produced may then be followed by restorative sleep, but the hypnotic does not directly or primarily induce natural sleep.

If too much of the hypnotic is given, the primary narcosis is not followed by restorative sleep, but continues for a long time, and results in fatigue of the cerebral cells instead of restoration. This effect is sometimes seen during the following day, especially in old people, and it shows in mental and physical depression and tiredness.

Hypnotic measures include drugs, hot baths, the establishment of proper conditions for sleeping, etc. They promote sleep either by lessening cerebral congestion, by producing cerebral anemia, or by directly depressing the cerebral cells. The hypnotic drugs act essentially in the last way, the sleep being the result of diminished mental activity and restlessness, and dulling of the perceptions. In other words, hypnotic drugs are narcotic. Their action resembles somewhat that of the general anesthestics, but is slower in its onset, less powerful, and more lasting, and is not intended to produce a deep stage of narcosis. It goes without saying that the drugs suitable for use as hypnotics must be capable of depressing the cerebrum to the sleep stage without any essential depression of the vital medullary centers. All hypnotics act with more power at the usual sleep time, and if a patient is in bed in a quiet, darkened room. In fact, if the patient is about and active, the ordinary dose of a hypnotic may scarcely produce even drowsiness.

Because of the peculiar nature of insomnia, the taking of hypnotic drugs may in many cases lead to a drug habit. On this account a physician should avoid, if possible, the repeated administration of hypnotics for long periods, especially with neurotic patients, and should endeavor to keep the drug-taking under his own control. If a hypnotic drug seems imperative, the prescription should be changed from time to time; but it is often possible, by very simple measures, to improve the patient's sleeping tendencies, and so escape the necessity for the use of drugs.

Some simple hypnotic measures are:

1. Avoidance of conditions that promote wakefulness, such as noisy or disturbing surroundings, active mental work just before going to bed, exciting plays, emotional music, or caffeine drinks in the evening.

2. Establishment of conditions that favor mental relaxation and sleepiness, such as a walk in the open air in the evening or a hot bath. If there seems to be a psychic demand for some drug, but no physical demand, a harmless remedy, such as sugar of milk in capsules, tablet triturates or pills (prescribed as "Pil. Blank"), or a bitterish dose by mouth, or a hypodermic of plain water (thought by the patient to be morphine) may be effective.

There are three types or degrees of cerebral depression which may be desired from hypnotic drugs.

1. Brief, mild depression - to induce the onset of sleep only, the sleep then tending normally to continue for the usual length of time; a glass of ale, for example, when a person is fatigued but cannot get to sleep because of excitement, mental activity, or restlessness.

2. Prolonged mild depression - both to induce sleep and to maintain it for a length of time, when the normal tendency to sleep seems to be absent, or when the perceptive faculties are overkeen so that waking is easy, as in fevers, neurasthenia, various neuroses, some forms of habitual insomnia, etc. An occasional drug for this purpose might be chloral hydrate or veronal.

3. Prolonged depression with analgesia - to produce and maintain quiet and sleep, in spite of pain or other powerful factors which tend to keep the patient awake, e. g., morphine. Drugs which abolish pain are "analgesic."

A hypnotic must be considered as to its effectiveness, its rapidity of action, its length of action, its power to overcome pain, and its safety. We might, for practical purposes, divide the hypnotics in common use into - (a) Those which do not abolish pain, as chloral hydrate, (b) Those which do abolish pain, as morphine.

A. Hypnotics Which Do Not Abolish Pain