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1--Acute Alcoholism
   2--Dipsomania
   3--Chronic Alcoholism
   4--Delirium Tremens

(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.

   This is a form of periodic drunkenness. Those coming under this head have seasons when they have no desire

whatever for drink, and, so far as their feelings are concerned they see no reason why they should ever get on another spree. But a time comes when the desire takes them suddenly, and before they have had time to think very much about it, they are drinking heavily. The duration of this condition varies in individual cases. Some will get over the desire in a week; others will stay more or less drunk for a month, and then sober up and be absolutely free from the desire or habit for months perhaps.

   This is brought on by years of tippling. Alcohol of a light order is taken continuously for years. Some people will use a light form of alcohol for ten years before they will begin to show any symptoms of alcoholism. The first symptoms are an undue redness of the face, and in some a tendency for taking on a large or distended abdomen. In most cases the first symptom is a deranged digestion--an alcoholic gastritis. This disease is seldom manifested in those who drink beer or light wines, especially those under thirty or forty years of age; but those who take whisky, brandy, or any of the other heavier drinks, may show symptoms of the disease in two or three years--from that up to ten years, depending upon the amount taken, and the resistance. The slow poisoning of the alcohol shows itself on the nervous system, causing more or less degeneration of the nerves, and, in gouty people, developing multiple neuritis.

   The effect of alcoholism on the blood-vessels is very great. It produces more or less dilation; the capillary blood vessels of the face will stand out very prominently; in some cases there is a pronounced network of enlarged capillary blood vessels over the cheek and nose. When these subjects lie down in a horizontal position, or with the head a little lower than the body, the face becomes suffused with blood, and a purplish coloring will show itself about the nose and eyes. Apoplexy threatens.

   Alcohol has a tendency to cheek elimination. It also checks tissue change, and causes more or less hardening of the arteries, and premature aging. High arterial pressure is common among those people who are steady drinkers, but who never get drunk. They sometimes run a pressure of 250, and even 280. When patients in this state are taken off the alcohol suddenly, they are liable to develop delirium tremens. Unsteadiness of the muscles, and tremor of the limbs and tongue, are common. Mental activity is reduced, causing dullness, especially at the time of day preceding the awakening of the sensibilities by the accustomed stimulation.

   The relation of alcoholism to insanity has been a muchmooted problem. There is no question but that a country inhabited by people who are in the habit of taking more or less alcohol will develop a race of very nervous, irritable, cranky people--people who will lose their mental balance very easily. The people in those countries that take more wine than any other alcohol are very nervous, irritable, high-strung, quick of temper. Those who drink beer are very sluggish, and more inclined to suicide. All people who get under the depressing influence of alcohol will be troubled more or less with delusion. Alcohol diathesis is in reality the suicidal temperament. People of a nervous temperament will be inclined to take on nervous diseases from the toxic influence of alcoholics.

   Epilepsy is a disease common among the extremely nervous types--especially in children of those who are in the habit of taking stimulants regularly.

Digestion is usually the first function to suffer. Chronic gastritis starts up in the regular toper, causing a thickening of the mucous membrane. The breath of the chronic inebriate is very offensive, There is often a metallic odor, which is characteristic of chronic irritation; and, when this is mixed with stale alcohol, the breath is indeed bad. The tongue is heavily coated, and the eyelids are granular. If tobacco is mixed with everything else, such subjects are exceedingly offensive.

   The next organ to be affected is the liver. Those who are inclined to eat too much starchy food, along with alcohol-tippling, will produce sluggishness of the liver. There will be so much inactivity brought on from drinking and heavy eating that the liver becomes enlarged. I have seen cases where the waistline was enlarged six to twelve inches on account of enlargement of the liver.

   There is a type of chronic alcoholism accompanied by a sort of atrophied state of the liver. These cases are incurable. Those who have enlarged liver are all curable, provided they can be induced to take the proper care of themselves.

   Acute Bright's disease is frequently brought on from the influence of alcohol. In some cases the kidneys become more or less enlarged, without showing any special change. Once upon a time alcoholics were given freely to tubercular cases. It was thought that alcohol had some specific influence in correcting diseases of the lungs. But as time has gone on, it has been found that alcohol hastens the development of tuberculosis in those who are predisposed to the disease.

   This disease develops in those who have been in the habit of tippling for years. Sometimes it requires twenty-five to thirty years to break down the nervous system to such an extent as to cause the victim to go into a state of delirium tremens. Men who have used alcohol steadily for years, but who have not been known to get drunk, some day may surprise their friends by developing delirium tremens.

   A patient with this disease will be very hard to control; indeed, some cases require a strait jacket. The cause is the long-continued action of the alcohol on the brain. The disease develops only in those who are habitual drunkards. Fever patients are very liable to develop an undue delirium, if they have been in the habit of using alcohol previous to their sickness. Pneumonia invariably kills in all cases of chronic alcohol poisoning; in fact, the drunkard cannot stand shocks or diseases of any kind. Fractures of the bone knit very slowly in these subjects, if they knit at all.

   Symptoms.--At the beginning of an attack of delirium tremens the patient is restless, sleepless, and inclined to be depressed. If he is given the usual amount of alcohol, the symptoms will immediately disappear, and he will be in what to him is a normal state. But if the alcohol is withheld, after a day or two delirium sets in; the patient talks continually, but the talking becomes incoherent; he is incessantly in motion, and wants to go out and attend to imaginary business.

   These patients begin by having hallucinations of sight and bearing. They hear voices, and see things that no one else can see. In this regard they are insane. Of course, it is an acute insanity. They see objects in the room; in fact, anything that happens to cross the mind will be objectified in the mental vision. Such cases have to be watched, and sometimes overpowered and restrained, because they have a tendency to injure themselves. If they are in an upstairs room, they are liable to jump out of the window.

   Treatment.--The disease requires no special treatment. In bad cases it would be well to put the patients in padded cells, so that they will not hurt themselves. They should be fed very moderately on fruit, or a little broth; in fact, while they are suffering very greatly they should not be given any food at all. Those with delirium have to be guarded to prevent them from doing themselves an injury. When better, they should be guarded to keep them from finding liquors of any kind.

   Most physicians use morphine, strychnin, and other stimulants to bridge the patient over the depression that follows, but I do not think that it is proper to administer one poison for the purpose of curing the effect of another. The patient may suffer a great deal for several days, but if he is kept entirely away from alcohol, and is properly fed, he will get through his suffering and be in a condition to sleep sweetly within a month. Then, if he is willing to do as he should, and take the proper care of himself, he may remain forever free from his health and brain destroying habit.

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