Of its Action on Animals, and Symptoms in Man.—Alcohol has been generally believed, since the experiments of Sir B. Brodie,[[2511]] to act on the brain through the medium of the nerves, and to do so without entering the blood. This may be doubted. At least in some experiments performed several years ago by Dr. C. Coindet and myself it appeared not to act so swiftly, but that absorption might easily have taken place before its operation began. At all events, through whatever channel it may operate, there is no doubt that it enters the blood; for in man the breath has a strong smell of spirit for a considerable time after it is swallowed; and it has been found in the tissues and secretions after death from large doses. Professor Orfila found that alcohol is a violent poison when injected into the cellular tissue; and that it produces through that channel the same effects as when taken into the stomach.[[2512]] In the course of our experiments Dr. C. Coindet and I found that it acted with great rapidity when injected into the cavity of the chest.
Authors who have treated of the action of alcohol and spirituous liquors on man, have distinguished three degrees in its immediate effects.
1. When the dose is small, much excitement and little subsequent depression are produced.
2. When the effect is sufficiently great to receive the designation of poisoning, the symptoms are more violent excitement, flushed face, giddiness, confusion of thought, delirium, and various mental affections, varying with individual character, and too familiar to require description here. These symptoms are soon followed by dozing and gradually increasing somnolency, which may at length become so deep as not to be always easily broken. After the state of somnolency has continued several hours, it ceases gradually, but is followed by giddiness, weakness stupidity, headache, sickness, and vomiting.
This degree of injury from alcohol may prove fatal, either in itself, by the coma becoming deeper and deeper,—or from the previous excited state of the circulation causing diseases of the brain in a predisposed habit,—or more frequently from the occurrence of some trifling accident, which in his torpid state the individual cannot avoid or remedy, such as exposure to cold, falling with the face in mud or water, suffocation from vomited matters getting into the windpipe, and the like.
Of simple poisoning by the gradual increase of coma the following judicial case in which I was consulted is a characteristic example. Two brothers drank in half an hour three bottles of porter, with which three half-mutchkins (24 ounces) of whisky had been secretly mixed by a companion, whose object was to fill them drunk by way of joke. In the course of drinking both became confused. In fifteen minutes after finishing the last bottle one of them fell down insensible, and had no recollection of what happened for twelve hours; but he recovered. The other staggered a considerable distance for an hour, and then became quite insensible and unable to stand. In four hours more consciousness and sensibility were quite extinct, the breathing stertorous and irregular, the pulse 80 and feeble, the pupils dilated and not contractile, and deglutition impossible. In this state he remained without any material change till his death, which took place in fifteen hours after he finished his debauch. A surgeon saw him when he had been five hours ill, but did little for his relief, as the case appeared hopeless.
There is a singular variety in the principal symptoms of this form of poisoning, even when completely formed. From a careful tabular analysis of no fewer than twenty-six cases, chiefly of the present denomination, collected by Dr. Ogston of Aberdeen from the experience of the police-office there, it appears that when the stage of stupor is fully formed, the person is sometimes capable of being roused, sometimes immovably comatose for a long time,—that the pulse is sometimes imperceptible or very feeble, sometimes distinct or even full, generally slow or natural, seldom frequent, very seldom firm,—that the pupils are occasionally contracted, much more generally dilated, and in a few instances alternating between one state and the other,—that the countenance is commonly pale, sometimes turgid and flushed,—and that the breathing is for the most part slow, and also soft, yet not unfrequently laborious, but very rarely stertorous. Convulsions are rare, having been observed twice only, and on both occasions in young people of the age of twelve or fourteen.[[2513]] Dr. Ogston has tried to group these several symptoms together in classified cases; but the general conclusions at which he arrives are subject to important exceptions. Neither do any of the special symptoms seem to bear a marked relation to the ultimate event. It is peculiarly worthy of remark, that very many cases got well where the pupils were much dilated, the coma profound, and the pulse imperceptible.
In the present form of poisoning with alcoholic fluids, it usually happens that if the stage of stupor be completely overcome, recovery speedily ensues, without any particular symptom except headache, giddiness, sickness, and the customary consequences of a debauch. Hut on some occasions the comatose stage is succeeded by one which indicates much cerebral excitement,—by flushed face, injected eyes, restlessness, a febrile state of the pulse, and delirium, even of the violent kind. In other cases this affection puts on very much the characters of a slight attack of typhoid fever.
In the second variety of the second degree of intoxication, an apoplectic disposition is called into action by the excited state of the circulating system; and death ensues from apoplexy or some other disease of the brain, rather than from simple poisoning. Thus in some instances, as will be more fully mentioned under the head of the morbid appearances, extravasation of blood is found within the head after death, preceded by the usual phenomena of ordinary intoxication. Since this is a rare effect of intoxication, it must be considered as the result of poisoning with spirits, exciting sanguineous apoplexy in a predisposed constitution. In other cases the stupor of intoxication, after putting on all the characters of apoplexy for two days and upwards, terminates fatally without extravasation. Here the poison operates by developing a constitutional tendency to congestive apoplexy. Again, this mode of action is still more clearly shown in some cases, where an interval of returning health occurs between the immediate narcotic effects of the poison and the ultimate apoplectic coma which is the occasion of death. Such a course of events, which, however, is of rare occurrence, is well exemplified in the following cases. A man drank 32 ounces of rum one afternoon, and was comatose most of the ensuing night. Next morning, though very drowsy, he was sensible when roused; and in the evening he was considered convalescent. But two days afterwards he became delirious; in two days more he died comatose; and congestion was the only appearance found in the brain.[[2514]] Another instance, most remarkable in its circumstances, is the following, which has been related by Dr. Golding Bird. A workman in a distillery, after drinking eight ounces of rectified spirit by mistake for water, suddenly fell down senseless and motionless, and remained so for eleven hours. He then began to recover, and came round so far that he returned to his work next morning. After this he continued to pass dark, pitch-like evacuations. In three weeks he became drowsy, mistook one thing for another, answered questions sluggishly, and had a frequent pulse, and dilated sluggish pupils; in which state he continued three weeks later when the account was published.[[2515]] The following case, related by Dr. Chowne, also seems to belong to the same category, although it presents anomalies. A boy, eight years of age, soon after swallowing about eight ounces of gin, said he felt like a drunk man, and suddenly became motionless and insensible. In no long time he vomited a fluid of the odour of gin; and in seven hours from the commencement a fluid was withdrawn from the stomach, possessing no longer any such odour. He was now motionless, insensible, pale, and cold; the pupils were contracted, the pulse feeble and hurried, the breathing stertorous and slow; and he made ineffectual efforts to vomit. Stimulants of all kind had little effect on him for a day and a half, when the breathing became more natural, and his look quite intelligent. Yet he could not answer questions, exhibited no sign of volition, and had a pulse so frequent as 160. In twenty-four hours more the breathing became laborious and rattling, and the lips livid; and death took place near the close of the third day. The only appearances of any note in the dead body were general injection of the arachnoid membrane of the brain, and effusion of frothy mucus into the bronchial ramifications.[[2516]] Similar to these is the following extraordinary case which has been communicated to me by Dr. Traill. A boy seven years of age, who was persuaded by two miscreants to take nearly five ounces of undiluted whisky, suffered for two days from the ordinary symptoms of excessive intoxication, which were then immediately followed by epileptic convulsions. These continued to recur with more or less violence, but always frequently, for two months down to the date of the judicial investigation to which the case gave rise. All these forms of the effects of drinking ardent spirits can scarcely be considered as simple poisoning, but as the result of poisoning developing a tendency to diseases of the head.
The third variety of poisoning with spirits in the second degree proves fatal, not in itself, but by some trivial accident happening, from which the individual cannot escape on account of his powerless insensibility. Thus, it is no uncommon thing for persons in a state of deep intoxication to fall down in an exposed place, where they perish from cold, or to tumble with the face in a puddle, and so be suffocated, or to be choked by inhaling the contents of the stomach imperfectly vomited, or by lying in such a posture that their neck-cloth produces strangulation. These statements are so familiar, that it is unnecessary to illustrate them by special facts. The reader’s attention was called to such accidents in the previous editions of this work. Two well-marked cases of the kind have been since published by Mr. Skae.[[2517]]