Alcohol

Alcohol is the product of fermentation ; distillation separates the alcohol from the fluid mass which contains it ; rectification gives us the absolute and pure alcohol. Alcohol is a colorless fluid of characteristic odor and of a burning taste. It is highly combustible, burns with a pale blue flame and gives out an intense heat. It has been exposed to very low temperature, without freezing.

It mixes with water in all proportions ; coagulates albuminous substances ; prevents the putrefaction of animal matter ; dissolves many organic substances, such as volatile and fixed oils, resins, etc. The charac- teristics given permit us to detect its presence readily. " In order to detect alcohol in liquids, supposed to contain it, let the suspected liquor be submitted to distillation with a gentle heat (as from a vapor or "water-bath) and to the distilled liquid add dry carbonate of

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potash, to abstract the water. The alcohol floats on the surface of the alkaline solution, and may be recognized by the characters above mentioned — especially by its power of dissolving camphor." Pereira.

The power of alcohol to prevent decomposition of organic matter and to hold in solution resins and other substances, not soluble, or partially soluble only, in water, makes it an indispensable article to the pharmaceutist. To the homoeopathic pharmaceutist the purity of alcohol is a most important item. The specific gravity at 60° F. should be 0.7947; at 68° R, .792. Alcoholometry is a test by which, with the aid of a hydrometer, the exact proportion of alcohol in any liquid can be accurately determined, "Its freedom from im- purities can readily be determined by pouring a few drops into the palm of one hand and rubbing it briskly with the other ; if a froth is formed, it indicates the presence of fusil oil.

If the hand remains unusually moist, it indicates the presence of an excess of water ; if the hand becomes dry and harsh, the alcohol is usually free from water." (Prof. Win. Owens.)

Alcohol is said to be a stimulant when given in small doses ; a nar- cotic when given in large doses. The so-called stimulating properties of alcohol have furnished the key-note to its medicinal use. In the ordinary practice of an intelligent homoeopathist stimulating treat- ment finds no place, and the stimulating effects of alcohol become to him what they really are, viz., the first stage in the development of alcohol-narcosis. A careful study of the different features of this narcosis, produced upon the healthy by various amounts taken into the organism and aided by experiments made upon animals, will furnish us with a true pathogenesis of the drug, giving us an under- standing of its modus operandi and of its proper sphere of usefulness as a medicine.

A moderate dose of alcohol is at once followed by a well-marked excitement of the vascular and nervous systems. The face becomes flushed, the eyes sparkle ; the countenance assumes an expression of cheerfulness ; the mind operates with remarkable freedom ; cares dis- appear ; the tongue becomes loosened ; the emotions, especiallv those of a kindly, affectionate nature, have free play. Soon the perceptive faculties become somewhat clouded ; indiscreet and incoherent language is used ; speech becomes faulty and blundering, and in many instances the sense of hearing is blunted. Unless the dose is repeated or has been large, these symptoms usually disappear during

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sleep, which is apt to be followed by a heavy confused ache in the head and by slight gastric disturbances. If the dose has been large or repeated, we find decided distubances of the intellectual faculties and of volition. The person becomes noisy; indulges in brilliant conversation, soon followed by senseless, unusual, obscene, coarse talk or by a tendency to quarrel with others ; some persons become exceedingly affectionate, shed tears without any occasion. The senses become confused ; vision blurred or double ; there is buzzing in the ears ; the articulation becomes indistinct.

The reasoning faculties become disturbed ; the face appears congested ; the pulse beats wildly, and at times a violent delirium declares itself. The gait now ceases to be correct, for voluntary motion is seriously im- paired. The giddiness increases rapidly ; nausea and sour vomiting set in ; the head aches intensely; the flushed state of the face has given way to an ashy-paleness ; unconsciousness steals over the ex- hausted frame, and the drinker falls into a profound, comatose sleep, accompanied by profuse perspiration, from which he awakens in due season with a confused, heavy feeling in the head ; dry, parched mouth, coated tongue ; disorded appetite and extreme lassitude.

This is the stage of intoxication.

If the amount of alcohol taken has been excessive, symptoms, even more grave than those described, develop themselves. Consciousness is wholly lost ; the face looks bluish or deathly pale ; the pulse is slow ; the pupils, at times, are contracted, but usually dilated ; breathing is slow and labored ; the mouth is full of froth ; coma declares itself ; and in manv instances death closes the scene. This is the apoplectic stage.

In some cases large doses of alcohol produce fatal results in a very short time. Mitchell mentions the case of a lad, ten years of age, who secretly drank from a whisky bottle, in imitation of his father, who was at work in the field. The sudden silence of the boy attracted the notice of the parent, when a wild, fixed gaze was dis- covered, that denoted something wrong. The father called the boy by name, but in vain ; and in less than an hour he was dead,

Orfila mentions the case of two soldiers, each of whom drank, in consequence of a wager, four quarts of brandy. Both of them died ; one immediately, the other while being taken to the hospital.

Morgagni speaks of the instance of an adult ^ian, who had been drinking heavily and remained unconscious and speechless for three days ; death took place on the fourth day.

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In Rust's Magazine the case of a laborer is related, who drank three quarts of brandy. He became thoroughly intoxicated and got into a wagon, which was driven by another person. Upon reaching home he was found to be dead.

Sproegel injected into the jugular vein of a large dog two drachms of absolute alcohol ; the animal was at once taken with a trembling of the whole body, increased action of the heart, intermitting pulse, and depressed respiration. For half an hour he refused to stir; after that he walked about in an uncertain, floundering way, occa- sionally lying down on one or the other side. He had also some convulsions, but s"oon regained his usual health.

Fontana says, that when half of the body of a leech was plunged in spirit, this part lost all motion, whilst the other half continued in action.

Flourens, an eminent French physiologist, gave six drops of alco- hol to a sparrow, at the same time laying bare his skull ; after a few minutes the animal became the very picture of intoxication in gait and manner of flying. As this increased, a red spot was observed on the skull in the region of the cerebellum, gradually increasing in size and deepening in color.

Anstie made the following experiment upon a dog, weighing 10 lbs. 4 oz. : Six ounces of a mixture, consisting of equal parts of rectified spirit of wine and water, were introduced into his stomach by an oesophageal tube, at 1 p. m. No food had been taken for four hours previously.

1:4. The animal is obviously affected: he staggers in walking, looks puzzled, and frequently falls down. On examining him care- fully, it is seen that the hind-quarters are very weak, and, moreover, the skin of the hind limb is partially insensitive. Respiration 24, circulation 140.

1:6. The dog lies extended on the floor, very drowsy, but capable of being roused ; the hind limbs are completely paralyzed, the fore limbs retain a slight degree of voluntary power. The conjunctiva is still fully sensitive, but the skin about the mouth and face seems to be entirely paralyzed as to sensation. The tongue is protruded, and the dog slavers somewhat.

1:7.30. The animal falls on its side, comatose and snoring. The conjunctiva is now equally insensitive with other parts. Respi- ration 20 ; circulation 184, tolerably strong.

While the animal remained in this condition, it was determined to examine whether any part of the body retained sensibility. It was found that the whole ano-genital region was still so far sensitive, that a slight whine of pain was elicited by pinching with forceps in any part of it.

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The pupil, during the first ten minutes after the effect of the alcohol became apparent, was strongly contracted ; at the end of this time it began to dilate, and at 1:25 it was seen to be perfectly dilated, and very little sensitive to light. Respiration had now risen again in frequency, to 30; the heart's action was 200, and somewhat irregular.

1:32. The dog made a slight struggle and vomited what was evidently a small part of the alcohol. The alcohol smell was dis- tinct. There was a slight improvement for a few minutes after this, partial consciousness apparently returning ; the anaesthesia of the sur- face, however, remained complete. Even the conjunctiva was per- fectly insensitive.

From this moment nothing worthy of note occurred, except that the hinder limbs were affected with a continuous tremor for a short time. Respiration gradually declined in frequency and became gasp- ing ; it finally ceased at 3:5, two hours and five minutes from the administration of the alcohol. The heart was then beating sixty- four times per minute, and continued to act slightly for a few minutes. It remained irritable for some moments later.

A careful examination of the effects of alcohol, as above described, shows, that the most important effect of the drug is exerted upon the nervous system, both motor and sensory, speedily extending to the great nerve-center, the brain, whose action it paralyzes more or less completely. Associated with these disturbances, which are patent to the most careless observer, we have the following, which are equally well-marked in the narcosis produced by chloroform and ether, and which depend upon disturbance of the sympathetic system ; namely : a, flushing of the face, increased heat of the ears, injection of the conjunctiva ; b, excessive rapidity, irregularity, or preternatural slow- ness of the circulation ; c, appearance of sugar in the urine from disordered function of the liver ; d, changes of the pupil ; e, excessive diuresis. (Anstie.)

A thoughtful reading of the articles on chloroform and ether will impress you wuth the great similarity of the action of alcohol with those agents and will assist in a thorough understanding of the fact, that alcohol is as energetic in its narcotic effects as those agents are. Nor must you forget the fact that a division between the stimulating and narcotic effects of this agent is rather arbitrary. A stage of stimulation or of arterial excitement, it is true, can be observed during the administration of alcohol, as it can be observed in the progressive action of the other narcotics mentioned. But that this arterial excitement is but the preliminary stage of alcohol-n^ro^, seems evident from the fact, that it is blended, even in the first and mildest degree of alcoholism, with difficult hearing, heaviness of the

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tongue and subsequently, indistinct speech, and confusion of the intellect, due, beyond doubt, to the paralyzing effect of the alcohol upon the brain.

If the use of alcohol is continued for a long time, constituting chronic alcoholismus, we find characteristic effects, as well marked as the symptoms of acute alcoholismus ; these depend in part upon the same causes, while many of them are due to the chemical action of the agent upon the tissues, which are directly exposed to its action. In chronic alcoholismus the stomach becomes seriously impaired. The gastric juice becomes modified and its digestive properties are destroyed by precipitation of the pepsin.

"Its prolonged use induces structural as well as functional changes in the glands of the stomach and hyperplasia within its connective tissue, which encroaches upon the glandular secreting structure ; and as a result we have such changes in the gastric juice that it will no longer effect the change in starchy, saccharine and fatty matters which are essential to their solution and assimilation, and they yield acetic, lactic and butyric fermentation, causing pyrosis, acid eructations, hiccough and the morning retching and vomiting of the toper." (Prof.

Wm. Owens.)

Scirrhous affections of the stomach, especially of the pyloric region, are of occasional occurrence. The writer held at one time a post- mortem examination upon the body of an habitual drunkard, and found in this ' case, a hardened, shrivelled-up state of the stomach which was truly remarkable. The whole mucous membrane pre- sented a dark-red, livid appearance, covered with patches of ulcer- ation ; near the pylorus the scirrhous state was well defined.

The liver becomes involved in the process of general breaking down. According to Oarswell, atrophy of its lobular structure is produced by the presence of contractile fibrous tissue, forming the so-called granulated liver of drunkards.

Dropsy and jaundice arise from pressure upon the portal vessels and upon the gall ducts. A similar structural change may take place in the kidneys, giving rise to various forms of B right's Disease.

As you may expect, the nervous system and the brain suffer greatly. The well known tremor of the drunkard's hand is the mildest mani- festation of a derangement, which culminates in the horrors of the delirium tremens — seu del. potatorum. Insanity finds one of its common causes in intemperance, as our reports from asylums prove beyond the possibility of a doubt ; and so destructive is the effect of alcohol upon the brain, that the very child, begotten during a state

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of intoxication of the parent, is in many instances thrust upon the world a helpless idiot, whose very existence is* an affecting, though often unheeded, appeal against the reckless use of this dangerous substance.

It is impossible to exhaust this subject in the limited sj>ace at our disposal. The various types of mania alone, the interesting nervous disorders, the odd and varied hallucinations, the neuralgic difficulties, the hyperesthesia and anaesthesia- of the drunkard; — each form a chapter by itself and prove only too conclusively how thoroughly the subtle poison permeates the entire system.

It is well known that alcohol is taken into the circulation, from the fact, that it has been found present in the various fluids of the body, in the fluid of serous membranes, in the liver, brain, and in the exhalations from the lungs. It has been stated upon excellent authority, that alcohol has been found in the ventricles of the brain, retaining its characteristic odor and inflammability. While Christison denies this possibility, claiming that coagulation of the blood would necessarily take place from the presence in the blood of a large enough amount of alcohol to produce such results, Carlisle, Percy, Pereira, Anstie and others, indorse the statement from actual observation and from the result of experiments made upon animals.

It has been claimed that alcohol is a food, and this statement is responsible for much of the indiscriminate use of the various forms of alcohol in medical practice. Evidence on both sides is strong, but not conclusive. Liebig classified it among the combustible foods, capable of replacing oily, starchy and saccharine materials of alimen- tation ; and his dictum was accepted without dissent, until later experiments seemed to establish the fact, that the system eliminated the alcohol by means of the excretions and particularly through the lungs.

The quite recent investigations of Anstie, conducted with great care, open once more a controversy which seemed settled. By a series of nice observations he claims to have proven that only a very small percentage of alcohol, taken into the system, can thus be accounted for ; and he fortifies his position still further by citing in- stances, where persons subsisted for a great length of time almost entirely upon large amounts of alcohol in some form, without the loss of an adequate amount of soft tissue.

The experiments of Dr. Anstie are too carefully made, not to be treated with the utmost consideration ; and until the conclusions, which he draws from them, are proven to be erroneous, they will carry with them much

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weight. As to the instances mentioned by him in which persons had subsisted for weeks and months upon a nearly exclusive alcohol- diet^ we must not forget that their not becoming emaciated may, in part at least, be accounted for upon the generally-accepted belief, that alcohol retards the waste of tissue.

But whether this question be decided in the affirmative or not, it is well understood that alcohol is by no means a food necessary to subsistence. The history of arctic explorations and of exposure to the scorching rays of a tropical sun ; the experience of the laborer on the farm, of soldiers in the field, all testify to the greater en- durance and longer-continued energy of the total abstainer ; and so fully is this realized, that in the armies of many nations the cup of coffee or of tea is distributed to the men in place of the former daily allowance of whisky or brandy.

As a therapeutic agent alcohol is a panacea for all possible aches of humanity in the hands of some practitioners, and wholly ignored by others. Externally used, it is an excellent styptic, acting as an astringent upon the tissue of the bleeding vessels and causing coagu- lation of the blood. Its application to burns is frequently followed by the most satisfactory results. In the sores of bed-ridden persons it acts well, and its astringent properties make it valuable in the treatment of extreme tenderness of the skin.

It is said to be an ex- cellent application for the removal of great soreness of the nipple in women, soon to be confined ; the wisdom of such treatment is how- ever very doubtful, as it tends to condense the tissue and renders them liable to crack, or fissure. Warm milk and water will usually be found preferable. Alcohol is also recommended as a gargle in sore throat, diphtheria, etc.

Its internal use is largely based upon its stimulating properties. Hence it has been recommended and is constantly prescribed for conditions marked by prostration of the system.

If used at all, alcohol must be prescribed as we give any other drug ; namely, in strict accordance with our law of cure. Hence it may be of use in the treatment of insanity ; paralysis ; softening of the brain ; dropsy of the brain ; sunstroke ; for the consequences of the bites of poisonous serpents and insects, whose effects correspond with the pathogenesis of alcohol, and in the treatment of the shock, resulting from mechanical injuries ; haemorrhages, accompanied by conditions which correspond to the pathogenetic record of the drug ; and in various types of fevers.

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We have described pathological states of the stomach which result from the prolonged use of alcohol ; in similar conditions it may act curatively. Its use in the treatment of consumption is of doubtful value. It gives momentary relief ; but the question arises, if this is not done at the expense of prolonged suffering and eventual shorten- ing of life.

In fevers it should be employed with the utmost caution, and only given when the totality of the symptoms points to it unerringly. Many a patient has been sent to an untimely grave, because the phy- sician in charge had more zeal than knowledge, and hoped to remove an unavoidable prostration of the vital forces, (due simply to utter exhaustion after a protracted struggle against disease,) by the un- timely administration of this agent.

Permit me to call your attention to the futility of giving alcoholic stimulants in large doses, and let me urge you to avoid wines and brands of whisky or of brandy, which are not perfectly pure. Since we have not space to consider the advantages of the various so-called stimulants, I will content myself with urging you to confine your- selves to a sling, made with absolutely pure alcohol, sweetened as the patient desires.

Of wines, those which are thoroughly fermented and somewhat acid, are preferable, containing only from six to twelve per cent of alcohol. Among these, Catawba. Clinton, Concord, Isabella and Delaware are to be recommended. The objection to imported wines lies in the necessity of adding a large percentage of alcohol to fit them for exportation.

Of beers, a good bottled lager contains a small per cent of alcohol and a liberal amount of nutritious substance. Heavy ales, porter, etc., are to be avoided.

In cases of poisoning by spirituous liquors the stomach must be emptied of its contents without delay. The application of cold water to the head and of warm water to the feet and the use of ammonia to the nose are to be recommended. Should respiration become depressed, it must be kept up by artificial means. Closure of the larynx calls for the performance of tracheotomy. Venesec- tion is recommended and may be performed in extreme cases.

Alcohol is used as an antidote in cases of poisoning by digitalis and tobacco.

ALETRIS FARINOSA. 201

ALETEIS FAEETOSA.

[STAR GRASS. NATURAL ORDER, H^MODORACE^.]

"Leaves broad-lanceolate; flowers white, oblong-tubular, pecli- celed ; perianth in fruit rugous or mealy in appearance. Smooth herb ; very bitter. Grows in low grounds, in most of the states. Root premorse.

Scape twenty to thirty inches high, with remote scales or bracts, and surrounded at the base with a circle of lanceolate, sessile leaves. These are three to four inches long, one-fourth as wide, and lie flat upon the ground. Flowers in a long, thin raceme. Perianth white, one-third of an inch long, on very short pedicels, rugous without, when old.

July." (Wood.)

The root contains an intensely bitter emulsive resin, soluble in alcohol, somewhat similar to aloes, but less cathartic. This bitter principle is also partly soluble in water. The tincture is rendered milky by water. Aletrin is prepared from the root, and is supposed to contain its active medicinal principles, but is not a reliable prepa- ration. (Hale.)

All there is known of the plant is derived from eclectic sources. The intensely bitter taste of the drug makes it, as a matter of course, a valuable tonic, used in many of their bitter mixtures even in pref- erence to quassia. Kafmesque urges the use of small doses, claiming large ones produce nausea, dizziness and narcotic effects, and that the powdered root should not be given in larger doses than twelve grains.

The plant is, as stated, used as a bitter tonic, for dropsy, dysentery, colic, ague, etc.

We have no provings. The following symptoms are given in Allen's Encyclopedia : Excessive nausea, with giddiness followed by vomiting and purging ; colic in the hypogastrium ; pressure in the uterine region ; premature and profuse menses, with labor-like pains.

The drug has been used to a limited extent only by homoeopaths. Beside the diseases above mentioned, Dr. King recommends it in hysteria ; also in amenorrhoea, dysmenorrhea and engorged condition of the uterus. Dr. King thinks it invigorates the uterine ligaments, thus curing prolapse ; he attributes to it also the power to prevent abortion.

Dr. Hale claims to have " found it a very useful remedy in cases of debility, general or local, arising from protracted illness, loss of fluids, defective nutrition, etc., with loss of appetite, myalgia, passive

292 ALLIUM CEPA.

haemorrhages, particularly uterine, and that condition of the uterus which predisposes to menorrhagia and abortion." The tincture of the root is the officinal preparation.

This remedy seems to act admirably during the first months of pregnancy, where there is vomiting, excessive nausea, giddiness, etc., with pain and colic in the hypo- gastrium, with a tendency to abort. A lady in her fourth pregnancy came to me with the above symptoms. She had suffered in this way during the three or four months of each pregnancy so much as to be obliged to keep her bed a great part of the time, and the third pregnancy was followed by an abortion at about the eighth week.

I gave her ipecacuanha, which relieved the vomiting, but not the nausea and giddiness. It occurred to me that aletris completely covered all the symptoms, and gave her a single prescription of the. tincture to be put in half a tumbler of water, and to take a teaspoonful every two hours at first. It gave her immediate and complete relief. She is now near her full term, in good health, except occasional neuralgic pains.

Troubles like the above are frequently met with in practice, and aletris seems to be nearly a specific [? — Ed.]. (Dr. Silas jones, Am. Observer, Vol. iii, p. 225.)