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.
For reasons which we have already explained, the patient should be
carefully preserved in a warm atmosphere; and his body should be placed
in an easy reclining posture, and be disencumbered of all tight
bandages. These precautions are of the utmost moment, for many of those
cases of inebriety which stand recorded in our journals, have terminated
fatally, for want of attention to them.