Acute. Chronic. Inebriety. Delirium Tremens.
The introduction of alcohol into the system always produces unnatural conditions; moderate quantities may cause no immediate appreciable symptoms because vitality may be able to overcome the effects, but in every instance vitality is weakened by the use of alcohol, and sooner or later must succumb in the effort to overcome the effects of the poison. When alcohol enters the circulation it is conveyed to every tissue, doing damage everywhere. It first irritates the nerves, which become depressed; it interferes with the proper oxydation of the blood, prevents normal tissue changes and interferes with nutrition.[1] Acute alcoholism is an archaic term, as alcoholism implies dependence. The American Medical Association, for example, defines alcoholism as a chronic disease.
Acute Alcoholism. — Persons unused to drinking alcoholic liquors, or those who consider themselves "moderate drinkers," are subject to acute alcoholism[1], which is commonly known as intoxication. It often presents characteristics of disease which are intense and often dangerous.
Symptoms. — After a period of excitement, drowsiness occurs, more or less profound, and with persons accustomed to drinking recovery soon follows. But with others drowsiness may run into stupor, the extremities become icy cold, breathing is slow and stertorous, and the heart action weak and irregular, the face livid and the lips blue.
Treatment. — An emetic of mustard in warm salt water should be given, or the stomach pump used; then follow by strong coffee, arouse the patient by walking him about, slapping him, or by the application of electricity. Dashing cold water on the head is useful. Follow by small doses of third preparation of lobelia (see formulas), three drops in water; allow quiet after recovery.
Chronic Alcoholism. — Persons who have long been accustomed to the use of alcoholic liquors suffer from this disease in one form or another. All the organs of the body, chiefly the stomach and liver, being affected. Symptoms may be summed up as follows[2]:
Treatment. — Various combinations of poisonous drugs have been employed to overcome the desire for drink; such as strychnine, atropine, daturine, chloride of gold, etc. These destroy the nervous system and only add to the deplorable condition. The only hope seems to be to confine the victim in some retreat, and there to endeavor gradually to overcome the various disordered conditions of the liver, stomach, bowels, kidneys, etc., and sustain the strength by tonics and most nourishing food.
- The stomach is inflamed (gastritis), there is indigestion, disgust for food, nausea and thirst; retching and vomiting in the morning of stringy mucus, often containing blood or shreds of membrane. Ulceration of the stomach is common. Inflammation in the mouth, throat and pharynx is always present.
- The bowels are inflamed and irregular. Stools are very offensive and often contain blood.
- The liver becomes altered in character; the bile may enter the circulation or the organ may become enlarged and undergo fatty degeneration.
- The substance of the kidneys becomes inflamed or profoundly congested.
- The heart becomes weakened and the blood vessels degenerate; hemorrhages in the brain may occur, causing paralysis. The nerves are shattered and will power is lost. Trembling of the limbs and mental disturbances follow. Cowardice, treachery and untruthfulness take possession of the mind and the victim is a physical and mental wreck.
- The outward appearances are familiar to all — bloating, redness of the face and congested veins over the nose and cheeks.
Delirium Tremens. — This usually occurs after a prolonged spell of drinking in persons already suffering from chronic alcoholism; sometimes it occurs with persons not in the habit of drinking, but who have taken perhaps their first large drink; and again, persons long accustomed to drink and who have been deprived of it may have an attack.
Symptoms. — Premonitory symptoms are usually manifested — sleeplessness, weakness, trembling, fear, bad taste in the mouth, constipation, and bad breath. The attack itself is accompanied by horrible delusions — usually most violent fear of reptiles, devils or other objects about to destroy the victim, who endeavors to escape them. The eyes stare, the body is covered with cold perspiration, the pulse is small and frequent, and violent trembling occurs. These symptoms may last several hours, and be followed by great physical and mental exhaustion.
Treatment. — Perfect quiet must be secured in a room well guarded, for the patient is liable to jump from the window or otherwise endeavor to escape imaginary enemies. For that reason a strong nurse should be present. Arguments are useless, strength alone can conquer. Often it is well to coincide with his ideas and bar the doors and windows and thus encourage the belief that the enemies are without, and he is safe within. Administer a strong infusion of scull-cap and cramp bark[3] in tablespoonful doses every hour, or by injection every two hours. For the injection half an ounce of each in a pint of starch water is not too much. Give most nourishing food — broths, raw eggs, milk, etc., highly seasoned. Give no narcotic, and above all do not administer liquor to "gradually wean him." Sleep is to be desired, but never by narcotics. The following will be found most excellent to administer in a capsule every three hours for the general exhaustion and heart weakness following delirium tremens: Sulphate of hydrastia, capsicum and salicin, each one grain. Weeks may possibly be required for complete recovery from an attack of delirium tremens.[4]
[2] The list of symptoms remains accurate.
[3] Scull-cap and cramp bark were both prescribed to treat muscle tension.
[4] Omitting possible complications resulting from delirium tremens seems strange - the condition had a mortality rate of 35% prior to contemporary intensive care medicine.