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.