This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
Treatment of Alcoholic Poisoning. In the acute cases, the prominent indication, in the earlier stage, is to evacuate the stomach; for which purpose recourse may be had to emetics or the stomach-pump. The latter is the most effectual method, though, in the absence of the necessary implements, the former should not be neglected. At the same time, cold water should be freely and steadily applied to the head, and sinapisms or other rubefacients, or hot pediluvia to the lower extremities. Pouring cold water into the ear has been recommended, in order to rouse the patient from stupor; and, with the same view, in its first application, it may be poured from a height on the head or shoulders. Bleeding, either general or local, or both, should be used when the pulse is full and strong, and organic mischief in the brain is apprehended. Should respiration be suspended or nearly so, it should be supported artificially, until nature may be able to maintain the function, or undoubted death shall have taken place. In the stage of prostration, after the direct action of the stimulant has ceased, and nothing remains but the depression consequent on the previous excitement, the system should be supported by external and internal stimulation. When the patient cannot swallow, the stimulant should be injected into the stomach or rectum. Carbonate of ammonia, or aromatic spirit of ammonia may be used, so far diluted as not to injure the mucous membrane; and even brandy may be resorted to, especially in the form of milk-punch by the stomach. It is not now the presence of the alcohol that is endangering life. It is the prostration; and that may be very properly counteracted by a smaller amount of the stimulus, so as to cause the system to subside gradually from its previous state of exaltation. This treatment, however, should not be employed until the skin becomes cool, the pulse feeble, and the danger from prostration obvious.
In chronic poisoning, the only remedy is abstinence. It is rarely that the affection has proceeded so far, that a cure may not be effected, or the state of the system very much ameliorated, by this measure. Unless some essentially fatal disorganization has taken place, as in cirrhosis of the liver, the system may be gradually led back to health by a reversal of the process which has brought it into the diseased state. A sudden withdrawal of the stimulus, without the substitution of something of a similar character, is dangerous. Death frequently results from this cause. Delirium tremens is an almost constant consequence, when the habitual excess has been great and long continued. The chief difficulty lies in the want of co-operation upon the part of the patient. The same infirmity of will that led to the evil, is in the way of its removal. I have often, however, had patients under my care in the Pennsylvania Hospital, who have been willing to submit to the requisite restraints, and invariably they have been dismissed without evil consequences, and cured for the present of the evil habit. The simple measure is to allow them at first somewhat less than their ordinary amount of stimulus, preferring the milder kinds when they will answer, as wines and the malt liquors, and daily to diminish the quantity, always endeavouring to sustain them above the point of sleeplessness or delirium. Opium often comes in very happily as an adjuvant, to obviate nervous disorder and produce sleep; but this also must be withheld, as the system is found capable of doing without it. Sometimes there is an advantage in partially substituting for the pure stimulus one of the bitter tinctures, especially that of hops; and recourse may be had to the nervous stimulants, as assafetida, valerian, and Hoffmann's anodyne, when nervous irregularities may seem to call for them. When the health has been materially impaired by the long continuauce of the habit, it is necessary, as the original stimulus is withdrawn, to address remedies to the system in order to correct the diseased functions, or repair the diseased organs; such as the bitter tonics and aromatics for dyspepsia, rhubarb and aloes for constipation, the chalybeates to improve the blood, and nitromuriatic acid or the blue pill to obviate hepatic disease.
When the patient cannot or will not summon resolution enough for a steady perseverance in the above plan, it is better for him to break off at once, and take the risk of the evil consequences, than to incur certain destruction from continuance in the vicious habit. Under proper medical superintendence, even should delirium occur, the case may almost always be conducted to a safe issue.
Of the management of delirium tremens I do not propose to treat in this place, as I have already fully considered the subject in my work on the Practice of Medicine. I would simply observe that, on the whole, I prefer the opiate plan of treatment moderately conducted, giving only so much alcoholic drink as may be sufficient to obviate prostration, and gradually withdrawing both.
There is one important practical point, however, to which I would especially invite the attention of the student. He is not to consider cases of meningeal inflammation or acute gastritis, when brought on by intemperance, and then mingled with delirium tremens, as instances purely of the latter disease. In these cases, he must deplete for the inflammation, while he supports the actions of the nervous centres by alcoholic stimulation, which, in drunkards, when given in less than the habitual amount, acts as a real sedative. The same rule holds in regard to inflammatory affections, which may come on accidentally in the intemperate, and, in consequence of the suspended use of the stimulant, become complicated with their peculiar delirium.
Dr. Marcet, of London, recommends the use of oxide of zinc in chronic alcoholic poisoning, beginning with two grains, twice daily, an hour alter meals, and increasing by two grains every three days, until the last dose amounts to six or eight grains. (London Lancet, April, 1859, p. 346).