Alcohol, moreover, is second only to opium, ether, or chloroform
as an anesthetic; indeed, has been used as a substitute for the latter. Hence, persons find experimentally that alcohol relieves pain, and its use is carried to a harmful extent, its deleterious effects produced, and inebriety established.
It is possible that a healthy individual, with good personal and family history, may use alcohol sociably or as a matter of custom, until the habit becomes firmly established.
The alcohol breaks down the constitution, invades and degenerates the nervous system, and thus develops inebriety, because the alcohol degenerations, or even functional disturbances of the nervous system, are the very conditions under which inebriety is established. We say this is possible, but we assert again that behind the large majority of inebriates will be found a defective family or personal history, not only complicating but causing the inebriety; retarding, oftentimes preventing a cure.
It can be thus seen that inebriety is but a symptom a flag of distress hung out by the nervous system. As some one has aptly said, , neuralgia is the cry of a diseased nerve," so the , drink craze " is the cry of the neurasthenic for a stimulant, of the pain tortured nerve for an anesthetic, of the victim of insomnia for a hypnotic.
Not any patient that applies for relief to the physician needs a more careful examination than does the inebriate. You may rest assured that there is some underlying cause, probably several that must be removed if we would restore the inebriate to his former habits of sobriety. If he is found suffering from the later manifestations of syphilis he will need special treatment for this condition, especially if the nervous system is involved; a painful stricture of the urethra may require division.
Chronic malarial poisoning with its complicating disorder of stomach, liver and spleen, will demand special treatment. In a case on record the irritation of a tape worm produced a tendency to the excessive use of alcohol, which tendency passed away when the worm was expelled.
In a word, a large majority of inebriates are diseased persons, and that primarily and antecedent to their inebriety, which is appended to and aggravates their diseased condition.
Special diseases, therefore, require special treatment, irrespective of the inebriety, if we would cure the inebriate. In this connection we may ask, are there any drugs that we can substitute for alcohol that will take its place, and satisfy the inebriate, as a substitute for alcohol ?
Opium and the salts of morphia will do so in a marked degree, although cocaine, chloral and the bromides have been so used.
The use of opium or morphia is not uncommon among inebriates who desire to ,leave off alcohol. The. inebriate, as a rule, is a congenital neurotic. From birth almost, he reaches out for some drug that will gratify or meet his neurotic craving. The alcohol and the opium habit to the inebriate are convertible habits, and the inebriate, like a pendulum, will swing from alcohol to opium; not infrequently the two habits are combined, as in the form of tinct. opii, constituting a mixed habit, in which the effects of both alcohol and opium have to be considered. Occasionally a case is presented in which morphia is used hypodermically, and the alcohol used in the usual manner. In cases where opium addiction is associated with the habitual use of alcohol, the opium habit is of paramount importance and the alcohol assumes a secondary place.
The fact that opium can substitute alcohol is the keynote to many vaunted secret cures, in the so called "narcotic treatment " for alcohol. It simply substitutes one habit for another, and as long as the victim is taking the so called remedy he is reasonably comfortable. But I admit if the " narcotic treatment " was carefully practiced, in judicious hands it might, in conjunction with such other remedial measures as would best eradicate the primal causes of the inebriety, prove useful, if not curative, in cases of inebriety.
Are there any drugs that are specifically beneficial for the treatment of inebriety as such ? We would state that drugs that act directly as a stimulant to the nervous system are of value. Strychnia is a type of this class of drugs, and one of the best of it class.
Luton, of Rheims, Belgium, was the first to point out its value in alcoholism. Then the Russians used it largely and it was known as the "Russian treatment," and finally, the Americans adopted its use in such cases.
Strychnia has proved serviceable as both abortive and curative in acute alcoholic delirium, as well as useful in the more chronic forms of alcoholism. It seems to be tolerated in such cases in cases of alcoholic poisoning under normal conditions, we have no record of the value of strychnia as an antidote; interesting experiment, , might be made on the lower animals with the view of determining this point. Strychnia is an excellent cardiac tonic, and one of the best respiratory stimulants, and might be used in general medicine in cases in which alcohol is oftentimes prescribed.
Oxide of zinc, during the past twenty years, has been used with advantage in cases of chronic alcoholic intoxication.
Quinine has been used more particularly in the later or convalescent period of the treatment of alcoholism.
The so called "Red Cinchona Cure" for a time interested the public. Rational medicine does not recognize any special drug or specific remedy as a universal cure for inebriety, nor does clinical experience form any basis for such a claim. From the very nature of the case, such a remedy would be impossible. The oetiology of inebriety is dependent on such a variety of causes and its environments and complications so numerous that any one remedy could not fulfill all, or even meet the more important of these conditions. However valuable drugs maybe to meet certain indications in the various conditions incident to inebriety, we believe that so far as the curative treatment of inebriety is concerned, drugs must assume a secondary place, valuable as they may be in their respective spheres.
In the treatment of the alcohol habit we place first: Restraint and seclusion in a special asylum for a definite period, and total abstinence during this period.
In a few words, concisely expressed, this statement, includes the Plan now adopted by the leading asylums of this country and of Europe for the recovery of the inebriate. It involves restraint, (legal, if need be), seclusion, a special institution, in which all the latest and best methods of dealing with the inebriate are procurable, a sufficient period in which to apply these measures, and we need hardly add, a long period of total abstinence from all alcoholic liquors. We need hardly add that diet, rest, recreation, hygienic surroundings, and the exhibition of appropriate drugs are all included in the above plan.
The causes of degeneration being removed, the factors of regeneration being brought into action, new formation of nerve, muscle and tissue must supplant degenerated tissue, if haply organic disease has not resulted in irreparable injury.
We have hinted at an hysterical element in the history of inebriety. The inebriate, whatever may be his condition, is largely influenced by his surroundings.
In the light it of such an hysterical element in the clinical history of inebriety, we can readily account for the apparent success of the so-called temperance movements that sweep over communities periodically and effect many apparent cures, or rather, in the language of the day, reformations. Such an element will also explain why, after such a tidal wave of excitement, relapses take place oftentimes in large numbers, and the period of excitement is followed by a period of reaction.
The occurrence of relapses is readily accounted for by the fact that the stimulus of the period of excitement buoys up the inebriate for the time being, during which strong mental emotion is a powerful factor. He is keyed up, as it were, for the time, and sustained by a moral stimulus. When this is withdrawn, reaction, followed by corresponding depression, sets in, and the old method of stimulation is again imperatively demanded and yielded to.
Why some inebriates go through such a period of excitement and do not relapse, and why others do, can be accounted for by the fact that the former are in a reasonable degree of physical health, and are not burdened, dragged down and handicapped, either by disease that is non alcoholic, or that is the result of alcoholic degeneration. The inebriates so affected are not influenced, or if at all, only temporarily, by the so called ,temperance revivals" that appear and disappear with almost stated regularity in large and small communities, and we must add do good, but only in the channel indicated.
It is also operating through this hysterical feature of inebriety treatment of inebriety is concerned, drugs must assume a secondary place, valuable as they may be in their respective spheres.
In cases where the hysterical element largely preponderates, we believe psycho therapeutical agencies, or even those that appeal to purely mental conditions, will be of service, but they will not cure a cirrhosed liver, lung, or kidney, or remove the physical causes upon which the inebriety may depend. In addition to those measures that appeal to the higher moral nature, there ought also to be combined such as meet certain intelligent wants. To this end all reasonable amusements, entertainments, and especially such occupations as will interest the person and keep him busy, should be encouraged, if not made compulsory.
Incidentally I may mention hypnotism as having been used especially by French physicians, with some benefit in cases of chronic alcoholism. I have no data to give, and have not had any personal experience with it.
The Bi Chloride of Gold cure, known as the Keeley cure, is in many cases successful, but not in all. Would advise its use as a last resort; though we think its use sometimes leads to insanity and suicide. It cures at all events for the time being.
If the temperance advocates would supply light, warm, cheerful Places of resort with hot and temperance drinks, supplied with pool and billiard tables where the poor could spend their evenings and meet each other and amuse themselves at a reasonable expense, and establish cooking schools for the wives where they could learn how to cook nourishing and palatable food which would supply the body with the nourishment which it must have and requires, we believe it would do more towards temperance than all the laws that could be passed.
Many prominent physicians who have made alcoholism a specialty, strongly recommend the immediate withdrawal of all liquors, and isolation from all company where habits and influence would lead to temptation, taking the following prescription faithfully for three or four months:
Sulphate of magnesia....one teaspoonful.
Nitric acid.............one teaspoonful
Sulphate of iron........one teaspoonful
Powdered cinnamon.......one teaspoonful
Sugar of milk...........three teaspoonfuls.
Distilled water enough to fill a six ounce bottle.
One teaspoonful frequently when the crave is on, and in a wineglassful of water.
Cold sponge bath also should be taken once or twice a day.
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