(1) Acute Alcoholism

Alcohol is supposed to be a stimulant. It is a diffusive narcotic and antalgic. It deadens sensation. When taken in large quantities, it will produce complete insensibility. Before the stage of insensibility is reached, there is an intermediate stage of semi-delirium where the patient is not conscious of his plight; in other words, he cannot see himself as others see him, and will go staggering about, making a nuisance of himself. If criticized for it, he will think he is abused; and if he is of a resentful nature, he may resent the abuse by undertaking to do bodily harm to the one offending him. The man of a benevolent nature will want to treat everybody kindly. If he has money, he will want to have everybody drink with him, and his tendency will be to give everything away perhaps throw money away recklessly. If he is inclined to be of a loving nature, he will make himself very offensive to any lady acquaintance whom he happens to meet. He knows what he is doing, yet he has lost all sense of judgment and propriety--his sense of proportion. In this state he can receive more or less bodily injury without being conscious of it, showing that the drug is more or less of a narcotic.

The toxic influence of alcohol is first noticed in a state of recklessness on the part of the one under its influence. Then the muscular system will lose its power of coordination in walking, the gait being that of a staggering from one side to the other of the sidewalk. This incoordination continues if the use of the stimulants is continued, until all power is lost and the victim goes down in a heap, unable to get up. This is called a state of drunkenness. Those who are heavy--in a state of obesity or semi-obesity--will have very flushed faces. If the weather is warm, they will look very much flushed, as if the blood pressure were high. Indeed, it is high, and those who naturally carry a high blood pressure will be endangered from drunkenness. They will be inclined to have a rupture of the brain. People whose blood is in this state in very hot weather are the first to be afflicted with sunstroke. This is the class of people who die from sunstroke in nearly every city of the country every year.

When a person is found in a state of drunkenness, these questions will arise: Is the individual drunk? Is he dead, or is he suffering from uremic coma, or from coma coming from any other cause?

Breathing will settle the question as to whether the individual is alive or not. Then to smell the breath will settle the question as to whether the intoxication is from alcohol or not. If from uremic poisoning, there may be a history of kidney disease; but where it is impossible to get the history of the case, the urine will have to be drawn off and examined, and the patient watched. If there is a suspicion of uremia, such cases cannot be put into a hot bath too quickly; for this will restore the action of the kidneys. Even if not necessary to find out whether there is kidney disease, it should be the duty of the physician to draw off the urine, in order to show if there has been a retention. Sometimes such cases carry from six to forty ounces of residual urine, and, to give relief, this should be drawn off.

People under the influence of alcohol to the extent of complete paralysis are very liable to get down and freeze to death in the winter time. It is said that Russia lost about 600 each year from this cause.