In treating of the action of this substance upon the human body, it may be considered as a slow, or quick poison; as one which, according to the circumstances of its administration, may either implant the seeds of disease and death, by an insidious, and scarcely perceptible operation, or extinguish the principle of animation in the space of a few hours.
Its effects as an accumulative[[470]] poison are principally interesting to the physician in their relations to therapeutics, although their history may perhaps suggest some few points of interest to the founders of medical police.
We shall, therefore, observe, with regard to the habitual use of fermented liquors, that the bodily evils which arise from the custom rather depend upon the quality, or, in other words, the state of combination in which the alcohol exists in such liquors, than on the absolute quantity of the libation, or the frequency with which it is repeated. Daily experience convinces us that the same quantity of alcohol applied to the stomach under the form of wine, and in a state of mixture with water, will produce very different effects upon the living body, as well with reference to the immediate symptoms, as to the remote consequences of the potation; it has, for instance, been clearly demonstrated that port, madeira, and sherry, contain from one-fourth to one-fifth their bulk of alcohol;[[471]] so that a person who takes a bottle of either of these wines, will thus take nearly half a pint of pure alcohol, which is equivalent to a pint of brandy! The remote consequences too of alcohol in these different states, are as striking and distinct as their immediate effects. It is well known that diseases of the liver are the most common, and the most formidable of those produced by the use of ardent spirits; it is equally certain that no such disorders follow the intemperate use of wine that is perfectly pure; let it be remembered that the greater proportion of that which is drunk in this country contains uncombined brandy, purposely added to meet the demand of the British market; and Dr. MacCulloch thinks that it is to the unwitting and concealed consumption of this uncombined spirit, that we ought to attribute the prevalence of those hepatic affections which are comparatively little known to our continental neighbours. But although wine, in a state of purity, may be thus fairly excluded from the general obloquy which attaches to spirituous potations, it must not be regarded as entirely free from imputation. “The effects of wine,” says Rush “like those of tyranny in a well formed government, are first felt in the extremities; while spirits, like a bold invader, seize at once upon the vitals of the constitution.” And even with respect to ardent spirits, although they can only be regarded as diluted alcohol, still each species appears to possess a peculiarity of operation; owing, no doubt, to the modifying influence of the other elements of the liquid; thus brandy[[472]] is said to be cordial and stomachic; rum more heating and sudorific; gin and whiskey, diuretic; and arrack, styptic, heating, and narcotic. It seems also that a modified effect is produced by the addition of various other substances, such as sugar and acids; which latter bodies, besides their anti-narcotic powers, appear to act by favouring a more perfect combination and mutual penetration of the particles of spirit and water. The effects also which are produced by the habitual use of fermented liquors differ essentially according to the kind that is drunk; thus ale and porter, in consequence of the nutritive matter, and perhaps the invigorating bitter with which they are charged, and the comparatively small proportion of alcohol which they contain, dispose to plethora, which is sometimes terminated by apoplexy.[[473]]
Symptoms of Poisoning by Alcohol.
The ordinary effects of an excessive dose of any spirituous liquor are too well known to require description; and generally pass off without the necessity of professional interference. In cases, however, where the draught has been very large, the person has suddenly fallen down in a state of complete insensibility, and has exhibited all the phenomena of apoplexy; or, in some instances, he has expired almost immediately. The insensibility of the patient may render it difficult for the practitioner to distinguish the immediate cause of the symptoms; although his history for the last few hours, and the spirituous odour of his breath, will generally announce the true nature of his situation. Mr. Brodie observes that there is a striking analogy between the symptoms arising from the ingestion of spirits, and those produced by injuries of the brain; concussion of the brain, which may be considered the slightest degree of injury, occasions a state of mind resembling intoxication; pressure on the brain, which is a more severe injury than concussion, produces loss of motion, insensibility, dilation of the pupils, laborious and stertorous respiration, and death.
Physiological Action of Alcohol.
We shall not enter into the history of the slow operation of repeated doses of spirit upon the human body; but limit our present inquiry to the modus operandi of this agent, as a quick and destructive poison.
Large draughts of liquids containing alcohol, would appear to destroy, at once, the functions of the brain, without occasioning that previous stage of excitement, which is produced by smaller quantities of spirit—whence coma and insensibility are the immediate consequences; and the nervous energy being no longer conveyed to the muscles of respiration, the breathing becomes laborious, and the patient dies, as he does in apoplexy, for want of those changes in the blood which are produced by the respiratory functions.[[474]] In the greater number, however, of fatal cases of inebriety, life has been destroyed by circumstances purely accidental; such as improvident exposure to cold, as explained at page [59], or suffocation from an imperfect act of vomiting, during which a portion of the contents of the stomach are forced into the trachea, (see page [58],[[475]].) It having then been clearly established that the brain is the organ principally affected by a large dose of alcohol, it remains to be explained in what manner, and through what medium such an effect is produced; upon this question we are inclined to concur with Mr. Brodie, and to consider that alcohol acts sympathetically on the brain by means of the nerves of the stomach; for it has been observed that animals which die under such circumstances, exhibit a decided inflammation of the stomach; and, in the next place, the effects produced by this agent are too instantaneous to admit the possibility of absorption, while repeated instances have shewn that vomiting will often restore the intoxicated individual to his senses. At the same time, we think it very probable that, upon some occasions, the alcohol passes into the current of the circulation, and is thus carried to remote organs. Dr. Cooke[[476]] has related a case, on the authority of Sir A. Carlisle, of a person who was brought dead into the Westminster hospital, in consequence of having drunk a quart of gin for a wager, at a draught; and that upon examination, a considerable quantity of a limpid fluid was found within the lateral ventricles of the brain, distinctly impregnated with gin. We well remember this case, for it occurred during the period that the author of the present work held the situation of physician to that hospital. See Pharmacologia, vol. 1, p. 138.
Treatment of Persons in a State of Inebriety.
In the first instance we should endeavour to evacuate the stomach; for which purpose a brisk emetic of sulphate of zinc, or tartarised antimony may be administered. Blood should also be taken from the jugular vein, or temporal artery; more especially if there appear a considerable determination of blood to the head. The head should be also washed with cold water, or some evaporating lotion.