diminished under larger doses. On the spinal cord the action of alcohol is depressing, apparently from the very beginning. Lack of coördination, leading to a staggering gait and blurring speech, are familiar. Reflex irritability is also diminished, and the spinal sensory areas ultimately paralyzed. On respiration, alcohol acts appreciably only in large doses. The function is only slightly, if at all, stimulated. Nearing death, the respiratory centre in the medulla is paralyzed. Alcohol increases the force of the heart-beat, and is a useful heart stimulant. It is a vexed question whether alcohol is a food. In one sense of the word it is. It is capable of being oxidized in the body, and is thus a source of heat and energy. Atwater has shown that at least two ounces of alcohol can be completely oxidized by the body in twenty-four hours and none of it be found in any of the excretory products. Alcohol, therefore, in a sense saves the use of fats and carbohydrates, and thus the body stores up fat for future use. This is one explanation why so many users of alcohol grow fat. The drug furnishes heat, and the fat is, therefore, not used up but is stored in the body. The doctrine that whisky warms the body is false. It really lowers the temperature, and the evaporation of the increased amount of perspiration further diminishes the temperature. It imparts a sense of warmth to the skin because it dilates the blood vessels of the surface. Persons who are to be exposed to cold temperatures would derive more valuable effects from hot drinks, such as coffee, or cocoa, or milk, from the eating of fatty food, starches, and sugars than they would from consuming any alcoholic drinks. After exposure is ended it may be useful to hasten reaction.
As alcohol is taken up directly into the circula- tion wherever it comes in contact with any tissue, an irritation is produced which, if continued for any length of time, results in the formation of new connective tissue cells. These, when formed in abnormal numbers in various organs, lead to disturbances in the function of these organs and ultimately to disease. The blood vessels become harder and lose their elasticity. (See Arterio- ScLEHOSis.) The liver may become larger and harder. The new connective tissue in the kid- neys may cause Bright's disease (q.v.). Acting on the brain, alcohol may cause alcoholic demen- tia; or acting on the superficial nerves, may cause neuritis. These are the results of chronic alcoholic poisoning, which probably exceeds all other agents as a cause of poverty, disease, crime, and death. Consult: Brunton. "The Phys- iological Action of Alcohol," in Practitioner (Volume XVI., London, 1876); Anstie's Stim- ulants and Narcotics (London, 1864): Atwater, United States Department of Agriculture, Bulle- tins 63 and 69 (Washington, 1897-98); Rosen- feld's Der Einfluss des Alkohols auf den Organis- mus (Wiesbaden, 1901). See Alcoholism; Antidotes; Brights Disease; and Intoxication.
AL'COHOLISM. The term employed to denote the symptoms of disease produced by alcoholic poisoning. In acute alcoholism, which is generally caused by the rapid absorption of a large quantity of alcoholic drinks, the first symptoms are animation of manner, exaltation of spirits, and relaxation of judgment. The emotions are altered and often perverted; muscular movements become irregular or ataxic;
the mechanism of speech suffers. The further development of the symptoms presents a variety of effects. In the ordinary course of the action of the drug, dizziness, disturbance of sight and hearing, and other troubles due to disorder of the central nervous system, ensue, leading to heavy sleep or profound coma, from which it is sometimes impossible to rouse the individual, who lies completely paralyzed, breathing ster- torously. Sometimes the alcohol affects so strongly the centres of respiration and circula- tion that death is caused by paralysis of one or other, or both. This condition of coma requires to be carefully distinguished from opium poison- ing. In the former, the face is usually flushed and the pupils dilated, while in the latter the face is pale and the pupils contracted. The odor of the breath is no criterion, inasmuch as sym- pathizing bystanders are apt to administer spirits in every case of depression, often with hurtful effects. Fracture of the skull, delirium of meningitis, and coma after epilepsy or after cerebral hemorrhage are often undiscovered by the inefficient ambulance surgeon, who is led to diagnose a condition from an alcoholic breath. A second class of alcoholics act in an entirely different manner. Instead of sinking into stupor or coma, the individual becomes more and more excited, bursts into wild mirth or passionate anger, struggles violently with those who attempt to soothe him, and may grievously harm himself or others. This is the condition known as alcoholic mania — the physical explanation of many fearful crimes. It is more apt to follow a somewhat protracted debauch. After a longer or shorter period of fierce excitement, it is in most cases succeeded by great depression, and sometimes during this condition there may be sudden death from failure of the respiration or circulation. In some patients the stage of excitement culminates in a convulsive seizure. The convulsions are repeated at intervals, are very complicated in character, and produce remarkable contortions of the body. These usually grow less violent, and, passing off, end in deep sleep; but here also death may occur from the action of the poison. Such cases of "alcoholic epilepsy" are comparatively rare, and occur principally in acute exacerbations of chronic alcoholism. Acute alcoholism is more apt to occur in those who are of unsound mind and weak nervous system, and this applies especially to the two last-described forms of the affection. In the treatment of acute alcoholism, it is always wise to wash out the stomach, in case alcohol is present, or to accomplish much the same object by free vomiting and purgation. In the profound coma, the administration of stimulants, such as ammonia and strychnine, may be called for, and sometimes artificial respiration may be the only means of saving life. In the maniacal and convulsive forms of the affection, sedatives must be used. After the immediate symptoms have passed away in all forms, the individual must be carefully fed with nutrient enemata, on account of the disturbance of the digestive system, along with remedies which will subdue the digestive irritation and overcome the depression of the nervous system.
Chronic alcoholism is caused by the prolonged use of overdoses of various alcoholic drinks. Changes (see Alcohol, Physiological and Poisonous Action of) are caused in every tissue of the body, but the nervous, respiratory, and
