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On This Day   January-04  (Benjamin Rush -1746 AD)

Benjamin Rush was one of the major political leaders who participated in the American Revolution and signed the U.S. Declaration of Independence in 1776 who insisted in medical freedom as in religious freedom but was not successful making it an article of the constitution...

 
 
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ALCOHOL & ALCOHOLISM
Light on an Old Problem
We are here concerned primarily with the characteristics of alcohol in its different forms, its physiological effects and the conditions of both health and disease in which its use may be helpful or prejudicial.
By virtue of its tendency to evaporate, that is, change into gas or vapour, alcohol is used extensively in medicine as a means of producing local coldness which will relieve pain, as in the well-known application of eau-de-Cologne for headache. On the same principle, evaporating lotions are used to relieve painful swellings, such as sprains; but it must be borne in mind that when evaporating lotions are used, the fluid must be put on gauze or material of open meshwork in order that the alcohol may escape; otherwise a blister will be produced. If alcohol is rubbed into skin it hardens the skin, as the spirit extracts the water of the skin.
When a person is kept in bed for any length of time, those parts of the body most subject to pressure, viz. the shoulders, the buttocks and the heels, are regularly rubbed with spirit, and then the area is dusted with an antiseptic powder, as one containing equal parts of oxide of zinc boric acid and starch; this proceeding tends to prevent the formation of bed-sores.
 
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Alcohol vigorously rubbed into the skin has a rubefacient effect, i.e. it reddens the skin by causing the small blood vessels of the skin to dilate so that more blood is brought to the part, and sometimes drugs are dissolved in the spirit either to increase rubefacient or counter- irritant effects or to apply anodynes for the relief of paing thus we have liniment of bella-donna, chloroform, etc.
Water containing 10 per cent., and upwards of alcohol acts as an antiaeptic, i.e. it will kill and prevent the growth of poisonous germs. Thus the surgeon will place for a few minutes his knife or the needles of his hypo-dermic syringe in alcohol (rectified spirit), which renders the instruments surgically clean and has the further advantage of not blunting them or causing rust to be deposited, as may happen when they are boiled. Alcohol can also be used to sterilize the surface of the skin before operations or even to cleanse a wound although it is a painful method.
Alcohol as a Food:
A question often asked is whether alcohol is a food. Sir Thomas Fraser says that it is a food in desperate cases, but one that requires careful medical supervision. The maximum amount of ethylic alcohol which can be used as a food by the normal body is one and a half onunces in any twenty-four hours, provided that it be taken well diluted and in divided doses. The equivalent of this amount of pure alcohol, expressed in the commonly used alcoholic beverages, is: One to two pints of ordinary beer or stout, one half to one pint of light wine, a quarter to half a pint of heavy wine, one-tenth to one-fifth pint of spirits. Beyond these amounts the alcohol is not burnt up in the body, but is passed off in the urine and in the expired air.
Not only can alcohol thus be used as a quick-acting source of energy and heat, but it probably has the power of conversing the proteins and fats of the body and so preventing undue wasting when insufficient other food is taken. For this purpose it should be given well diluted, and in small, frequently repeated doses. In this way the wasting often associated with chronic disease can sometimes be lessened. In every acute illness such as pneumonia and severe typhoid fever, if it is found difficult to get food taken by the patient, alcohol may be of great service.
Digestive and General Stimulant Effects:
By its local stimulant action on the walls of the stomach in cases where the activity of the muscles and secreting glands of the stomach is impaired, as in illness or old age, alcohol may be very useful aid to digestion. Taken with a meal, light wines and diluted spirit aid digestion by their local stimulating action. By its action on the central nervous system alcohol allays worry, removes the sense of fatigue, and so helps indirectly to better digestion. Generally speaking, the use of wine and ale with meals tends to promote good digestion, and its so-called tonic action owes much to this fact.
In cases of severe flatulent distension of the stomach which may endanger life by interference with the heart’s action, an ounce or two of neat brandy or whisky will be found of great help in expelling the ëwind.í
Alcohol is popularly thought to be a stimulant, and this is erroneously supposed to be due to its direct action on the heart and circulation. This effect may, doubtless, be attributed to its local stimulant of the stomach, which indeed may have a passing reflex response in the heart. Alcohol by itself has no direct stimulating effect on the heart. What it does is to dilate the blood vessels of the skin and thus ease the work of the heart. In cases of severe chill this action may be of great service, since it helps to relieve internal congestion. Alcohol should only be used for this purpose if the individual is to remain in the warm until the effect entirely passes off. Otherwise a further chill would easily ensue. In temporary cerebral anaemia (i.e. fainting) alcohol in small concentrated doses is a well-established remedy. But it must be quite certain that it is a faint and not any other form of "seizure" (see Apoplexy).
Alcohol as a Sedative:
Here we have the real and most general use of alcohol. It has a powerful sedative effect on the central nervous system, acting first on the highest order of nerve cells in the brain and successively, if given in continuous doses, on lower centres, and finally on the centres controlling the vital processes of the body. Brain cells which subserve memory, the higher intellectual powers and latest acquired achievements of the race are the first to be affected. Hence the blotting out of disagreeable thoughts and sensations, by means of which the taking of alcohol tends to produce a feeling of well-being and happiness, and to abolish the sense of fatigue and of mental unrest.
Hence also the fact that highly skilled work and the powers of judgment and attention are soon impaired in quality under the influence of alcohol. Thus it is very unwise and may be criminal to drive or to be in charge of a motor car even when slightly under the influence of alcohol. With successive doses the sense of propriety and decency becomes affected, and the individual behaves in a manner foreign to his normal conduct. Next the speech centres and the lower centres which control the balance of the body and the gait come under its influence. Finally, unconsciousness supervenes and even death may follow.
In cases of illness, especially when associated with pain or great discomfort, alcohol carefully given may be very useful on account of its sedative action. With some people a small dose of alcohol at bedtime will promote sleep.
The alcohol used for the above purposes is ethylic or vinous alcohol. Absolute alcohol contains 955 per cent.; rectified spirit, 90 per cent.; genuine brandy, 40 to 70 per cent.; rum, 40 to 54 per cent.; gin or hollands, 25 to 50 per cent,; whisky, 40 to 54 per cent; liqueurs 40 to 52 per cent.; port, 15 to 25 per cent.; sherry, 15 to 20 per cent.; Madeira, 10 to 14 per cent.; claret, champagne, Burgundy, hock and Chianti, 9 to 12 per cent.; stout and heavy beer, 5 to 9 per cent.; light beer, 2 to 5 per cent.
Wines are obtained by the spontaneous fermentation of the juice of the grape; spirits are obtained by distillation; brandy from wine, rum, from molasses; gin or hollands is spirit flavoured with juniper and sweetened with sugar; whisky is spirit which requires mellowing to get rid of fusel oil and other impurities.
 
Beer differs from wines or spirits in being definitely nutritive, since it contains a large percentage of albumin, carbo-hydrate and, fermentation not being completed, a proportion of yeast cells.
ALCOHOLISM: PREVENTION AND CURE
Methods of Combating this Morbid Condition
Here are described the forms of chronic poisoning that may be established by excessive use of alcohol Medical treatment likely to prove beneficial is indicated and stress is laid upon the psychological influences that alone are likely to be entirely curative. See also such headings as Delirium Tremens; Dipsomania; Drug Habits; Insanity; etc.
A person may get drunk and still not be, or become, an alcoholic in the sense of an habitual drunkard; it may be merely an episode in his life. No description of drunkenness will cover all its possible manifestations, for the simple reason that different individuals react in various ways to the effect of the drug. The dose necessary to cause drunkenness is not the same either for all persons or even for the same person at different times and in different circumstances.
Alcoholics may be divided into two classes -those who have gradually become accustomed to taking an excess of alcohol and at last reach a point where they cannot do without it; and those who, from the first, have taken it as a means of escaping from reality. But even the members of the former group also reach a point where they, too, cannot face reality without alcohol.
In attempting a cure, however careful we are to do all we can for the patient's physical health, we are unlikely to affect a cure unless we can gradually re-educate the patient to a point where he is able to face life and adapt himself to it without alcohol. Psychological treatment by a specialist offers far greater hope of cure than all the much vaunted "cures" for drunkenness.
Alcohol, it has been well said, exaggerates the normal temperament. The weak man under its influence becomes foolish, the morose man weeps, and the excitable man becomes merry and exalted. Generally speak ing, the immediate effect of alcohol is to produce a feeling of well-being as explained under the heading Alcohol. From this stage of ex hilaration we pass on to the second, that of inebriation, when the drug is continued or the dose has been very large; this is the paralytic stage. All sensations are blunted; speech be comes thick and difficult; the body movements become unsteady and purposeless. The third stage is that of deep sleep, stupor, or coma. Unconscious, the victim lies inert, breathing noisily or stertorously; the skin may be wet from sweat, and he may die from paralysis of his breathing apparatus. This third stage indicates acute poisoning.
The condition in this advanced stage is easily confounded with the onset of other poisoning, apoplexy and other serious states difficult for an experienced practitioner to diagnose upon occasion; and no layman is justified in concluding that an unconscious man is drunk because he cannot walk straight or talk intelligibly, or because his breath smells of alcohol.
In cases of this kind if the patient is unconscious a doctor must be sent for. Meanwhile, the neck and chest must be made free so that he can breathe freely; he must be kept warm, as in this condition he is very liable to take a chill, and he must be allowed to sleep. Artificial respiration may be required in cases of poison ing when the patient is both drunk and dying.
The ill-effects of over-indulgence in alcohol take on several forms of varying degree of severity, as expressed in the symptoms, but undoubtedly the condition most commonly met with is that of chronic alcoholism, due not to frequent drunkenness but to a persistent "soaking." It is very frequent amongst women. There are certain critical ages when the danger of falling a prey to the drug is urgent. Amongst women the period between 40 and 50, the time that the change of life is due, is particularly dangerous.
As a drug, alcohol is dangerous; only to be used with caution in the hands of a medical man.
To seek frequently either relief from pain or a stimulus for some extra effort, whether mental or physical, in a dose of alcohol is to court disaster.
The effect of the drug is only temporary and the reaction is marked; the condition of exaltation and superiority to trouble is followed by a depression lower than that of the original condition calling for the stimulus, and this subsequent depression suggests the remedy again and more often. No alcohol should be taken between meals, and unless one is certain of possessing the necessary self-control it should be avoided altogether.
The constant partsking of alcohol shows its mark on the digestive system, the liver, the kidneys, the heart and circulatory system, and upon the nervous system. Digestive disorder is shown by loss of appetite, especially for the breakfast meal. Early morning nausea and the vomiting of phlegm or mucus is the first show of resentment by an outraged stomach; windy spasms, with heartburn, worry the patient; in a word, he suffers from gastric catarrh.
Serious Results of Continued Drinking
Alcohol continually present in the blood stream acts as an irritant poison to the internal organs and tissues of the body. Since all of it absorbed from the stomach and intestines must pass directly through the liver, this latter organ becomes, in time, seriously damaged. It becomes hardened by formation of fibrous tissue or its cells become degenerated. The result is known as cirrhosis of the liver. The organ becomes hard and shrunken or swollen and enlarged.
Similarly the kidneys, through which much of the alcohol is excreted from the body, become irritated and inflamed and may develop the condition known as chronic Brightís disease.
Similar degenerative changes occur in other organs such as the heart, and in the central nervous system and peripheral nerves.
Another result is the overproduction of fat, which, being deposited among the heart muscle, interferes with its action and lessens its power, rendering it liable to sudden failure. The heart muscle also becomes degenerated from the direct action of the alcohol. Changes producing thickening and loss of elasticity in the blood vessels, with a rise in blood pressure, may presage an attack of apoplexy. The walls of the small vessels which bring nourishment to the heart substance are also implicated, with the possibility of attacks of severely painful cramps in the region of the heart and anging pectoris (q.v.). Gout is another condition associated with alcohol, especially when beer or port wine is freely drunk.
So much for the general effects. The effect of chronic drinking on the mental powers must now be considered.
There is a failure in the powers of application and concentration, and the memory also fails to a marked degree. The intellectual faculties progressively fail. The victim becomes at last not only incapable of perform ing his accustomed task, but even of looking after himself or his affairs. He becomes irritable and breaks into a passion upon slender provocation; suspicion of those about him becomes marked. There is also a pronounced deterioration in his moral nature. He may develop hallucinations or delusions. It follows that he may easily commit some breach of the law and bring trouble upon himself and his family.
Early and energetic treatment in a home or hospital may save some-those whose self-respect and self-control can be re-established -but the larger proportion fall victims to some inter-current disease or become afflicted with chronic delusional insanity. These people frequently die suddenly whilst suffering from quite minor conditions of ill-health.
Alcoholic Neuritis:
Neuritis or inflammation of the nerves is the result of poisoning, which may be by lead, arsenic, alcohol, or the poison which is produced when the diphtheria bacillus grows in the body. The alcoholic form occurs in those who have drunk to excess over a prolonged period of time. Both beer and spirits will cause the trouble; and both sexes are liable to be affected.
The earliest symptom is a loss of power in the legs. The sufferer finds it difficult to lift his feet clear of the ground, and in consequence he assumes a peculiar gait which is known as ìhigh stepping." The muscles which have lost their power waste and, along with the paralysis, pain is experienced, often very severe. There is frequently some degree of colour blindness, and occasionally sight may be lost.
The first treatment is to stop the poison. Rest in bed should be enforced, massage with electrical treatment administered, and atten tion paid to particular symptoms.
Alcoholic Insanities:
Spirits are by far the most potent cause. Some people's capacity for resistance to the effects of alcohol is very slight, and even a small amount produces serious consequenccs. Amongst the susceptible class are those born with a tendency to nervous instability, epileptics and those who suffer from occasional attacks of insanity. Other people acquire intolerance to alcohol; for instance, those who have suffered from sun stroke concussion of the brain prolonged febrile conditions, or who have long been addicted to excessive drinking.
Chronic Alcoholic Insanity:
The cause of chronic alcoholic insanity is persistent drink ing over a lengthy period. In some cases a steady and increasing degeneration of the mind continues, until in the end dementia (loss of mind) results. Mental confusion or stupor may show in other cases or a state of insanity associated with delusions ensues. Others, again, become generally paralytic.
The outstanding feature is the progressive degeneration of the intellectual faculties. Memory is lost; the patient becomes dirty in his habits and is unable to control the exercise of the natural body functions. While any mind remains there may be hallucinations and delusions, particularly delusions of persecu tion. The physical symptoms are much the same as those enumerated under chronic alcoholism. There is a chance for some to recover if placed in a mental home.
Mania-a-Potu:
This is another form of acute alcoholism. The typical symptoms are the extraordinary excitement and violence of the victims. The family history usually shows insanity somewhere. These people are very susceptible to alcohol and very little throws them off their mental balance. The onset of the illness is sudden. There is a distinct tendency to homicide. The victim is very extravagant and lavish with his money. He boasts and is egotistical, noisy and quarrelsome.
Delirium tremens, another form of acute alcoholism, and dipsomania, which is a periodic constitutional craving for alcohol, are dealt with under their own headings.
Treatment of Inebriety:
Various drugs have been used to combat the craving for alcohol. In one special treatment the mixture used was found to contain alcohol, strychnine and a non-alkaloidal bitter principle generally considered useless. Another special treatment depends upon increasing doses of atropine and strychnine alternated with a mixture containing Peruvian bark and sal volatile. It has had some favourable reports; in three cases the health improved, but the craving remained.
It is impossible to believe that any drug can redeem a person who is addicted to chronic alcoholism; the most it can do is to supplement other forms of treatment; isolation, open-air exercises and the like, and beside these it is relatively unimportant. Undoubtedly drugs like strychnine and cinchona, which are tonic in their action, will aid in restoring appetite, assisting digestion and generally increasing bodily fitness; but in order to help these people it is necessary that they be separated from their surroundings and removed from all their temptation-in other words, they must be placed in some home where they are under control.
At first it may be necessary to put them to bed, to administer a very light diet, and over come their sleeplessness and steady their nerves by the administration of sedatives drugs. Whether suddenly or gradually, the patient is eventually deprived of all alcohol; he is provided with plain nourishing diet, condiments being avoided as far as possible; he is encouraged to take exercise, take part in games, and generally to occupy his time.
In many retreats the patient is not allowed out without an attendant until he has had three months' treatment; after which time ho is given permission to go abroad for gradually increasing periods, according to his capacity for avoiding temptation. Although many free-livers will subject themselves to such a course of discipline at regular periods, there is a grave danger that these cases relapse.
There is some chance of redeeming an acute case; but where the moral and nervous systems have been undermined by long abuse of alcohol or drugs it is difficult to anticipate such a tightening of the moral fibre as to produce a self-control which, in the presence of inevitable temptation, will keep an individual from satisfying a longing repressed but not eradicated.
The effects of auto-suggestion (q.v.) have been equally disappointing, as, indeed, might be expected, since a person easily influenced must be one of weakened will. Success in a few cases has been claimed by doctors who practise hypnotism.
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