Enough has already been said of the value and limitations of alcohol as a therapeutic agent. As a beverage, when constantly used, it is liable to cause obesity, gastric indigestion, arteriosclerosis, myocardial degeneration, chronic nephritis and cirrhosis of the liver. Its first action is undoubtedly as a food, if not too large amounts are taken, and therefore it is a protector of other food, especially of fat and starch. A habitue, then, especially if he has reached the age at which he normally adds weight, increases his tendency to obesity, and the first mistake in his nutrition is made. If lie takes too much alcohol when he eats or afterward, his digestion will be interfered with. Sooner or later, then, gastritis and stomach indigestion develop, with consequent intestinal indigestion. If lie takes strong alcohol, like whisky, oil an empty stomach, he may sooner or later cause serious disease of the mucous membrane of the stomach, first chronic gastritis, and later atrophy of the glands of the stomach.
Alcohol with meals which contain meat tends to the production of an increased amount of uric acid. Alcohol taken before meals on an empty stomach causes sudden vasodilatation after absorption. It goes quickly to the liver, irritates it, and little by little causes congestions of the liver, so that sooner or later sclerosis of this organ develops.
Alcohol probably causes arteriosclerosis not by its action per se, but indirectly by causing gastro-intestinal indigestion and insufficiency of the liver, as a result of which more toxins circulate in the blood, tending to produce arteriosclerosis. Sooner or later these irritants cause kidney irritation, and chronic interstitial nephritis may develop. just which process becomes the farthest advanced and finally kills the patient is an individual proposition and cannot be foretold. The finale may be cirrhosis of the liver, uremia, arteriosclerosis, apoplexy or myocarditis with dilatation or coronary disease.
While small, more or less undiluted closes of alcohol, as whisky or brandy, may cause quick stimulation of the heart by reflex irritation of the esophagus and stomach, vasodilatation occurs as soon as the alcohol is absorbed, and if large closes are absorbed, vasomotor paresis may occur, temporarily at least.
During acute fever processes with an increased pulse rate, provided shock or collapse is not present, small or medium-sized doses of alcohol, by dilating the peripheral blood vessels and increasing the peripheral circulation, may relieve the tension of the heart and slow the pulse by the equalization of the circulation. Some of this action may be due to the narcotic effect of alcohol on the cerebrum. Alcohol may thus in many instances act for good. Overdoses, as shown by cerebral excitation, flushing of the face and increased pulse rate, will do harm; in fact, many a patient with a serious illness, as typhoid fever or pneumonia, is made delirious by alcohol. Large doses of alcohol in shock or collapse are contraindicated.
Chronic overuse of alcohol may cause chronic myocarditis and fatty degeneration of the heart, with later weakening of the heart muscle and dilatation.
In acute alcohol poisoning the pulse may become very rapid and weak, and the patient may die of heart failure. This is often seen in delirium tremens. The administration in this condition of enormous doses of digitalis by the stomach is inexcusable, and the reason that such patients survive such digitalis poisoning is that the stomach does not absorb during this cardiac prostration.
A treatment as successful as any in this heart weakness in delirium tremens is morphin sulphate, 1/2 grain, and atropin, 1/15 grain, given hypodermically, with the administration of digitalis hypodermically for its later action on the heart. If the heart is contracting very rapidly, an ice-bag over the precordia will often quiet it. If the pulse is very weak, the cerebral sedatives more frequently used in delirium tremens, such as chloral, bromids, paraldehyd, etc., are generally contraindicated. A hot foot-bath and an ice-cap on the head sometimes aid in establishing a more general equalization of the circulation. It may often be necessary to administer strychnin, although if the patient is greatly excited it should be withheld as long as possible. For the same reason camphor, coffee and other cardiac stimulants which cause cerebral excitation should be withheld.
If the patient is in alcoholic coma, the pulse is generally slow, although it may be of low pressure unless the patient is otherwise diseased. Caffein or coffee is here indicated, and the patient should be kept warm lest he lose necessary heat. The stomach should be emptied by an emetic, often best by apomorphin hypodermically, unless the pulse is excessively weak. Strychnin may also be given, and digitalis, hypodermically, if it seems indicated. Camphor is another cardiac and cerebral stimulant that is valuable in these cases.
The treatment of an actual degeneration of the heart from overuse of alcohol is similar to the sane condition from other causes.