EARS.
Singing in the ears, or rushing and roaring noises are not uncommon; hallucinations of hearing are also not uncommon, such as imaginary voices, talking, or shouting; in chronic alcoholismus they are not constant, but occur most frequently in the evening and about midnight; the patient may even imagine that he hears singing or instrumental music. Ringing in the ears, which has arisen from mere debility, from excessive loss of blood, is often cured by the judicious employment of alcoholic stimulants.
NOSE.
Hallucinations of smell are not common; but the patient may imagine that his room is full of vapors of Sulphur, or suppose that the devil has defiled his bed, and that this smells as the devil is supposed to do. – J.C.P.
MOUTH, TASTE.
Great dryness of the mouth is a common effect of Alcohol, although the tongue is commonly moist in delirium tremens. Hallucinations of taste sometimes occur in alcoholismus- chronicus, and the patient may suppose that all the drinks which are offered him taste more or less of Alcohol. – J.C.P.
The excessive dryness of the mouth and tongue which so often accompany typhoid and malignant fever, is sometimes materially diminished by the use of Brandy or Wine. When other phenomena correspond, such as delirium, optical hallucinations, depression of the nervous system, Alcohol is homoeopathically indicated, and should be prescribed without hesitation. – J.C.P.
STOMACH.
Derangements of the stomach are very common in drunkards; among the chronic effects, the most frequent is vomiting, viz., the well-known morning-nausea and vomiting. At first the throat seems full of mucus, which is hawked up with difficulty; this becomes more and more difficult, and finally inclination to vomit and actual vomiting occur, caused at first by the attempts to hawk up phlegm, but finally they occur without this, and are attended with a feeling of oppression, discomfort, tension, and aching in the epigastrium. Besides the morning-vomiting, these symptoms may also occur more or less frequently during the day, especially after eating and drinking. These gaggings or vomitings of drunkards are preceded for a longer or shorter time by a feeling of pressure or tension below the breast, by fullness and distension after eating, by sour or putrid eructations, rising of water in the mouth. In the morning, a tough, or sour or bitter, or saltish or insipid water is raised; during the day, the food, more or less altered or digested, is brought up, but the vomits are always more or less sour of offensive.
The tongue is more or less furrowed or cracked; the furrows either run the whole length of the tongue, or else are confined to the tip; the fissures, like the furrows, may be deeper or smaller, straight or crooked, or in zig-zags, but they always run from the median line of the tongue towards the edges; the surface of the tongue may be furry or fibrillated, but it is more frequently scraped, robbed of its epithelium, and as if vanished; in such cases it is flesh-red in color, with enlarged papillae at its tip. The appearance of the tongue varies in the same person, according as he drinks more or less, or the stomach is more or less irritated. The trembling of the tongue has already been alluded to.
The breath has an offensive smell, especially while digestion is going on, arising in part from the evaporation of alcohol from the bronchial mucous membrane, in part from the eructations, and in part from the filth in the mouth and between the teeth.
The mucous membrane of the throat is often unnaturally red, and has a feeling of stiffness. That of the oesophagus is generally in the same condition, as is evident from the burning or slightly painful sensation which is frequently felt in swallowing.
The stomach may be sensitive or not, tense or relaxed, according as it is filled with food, air, When emaciation commences to take place, the recti muscles, especially that of the right side, becomes rigid, and cannot be relaxed. The appetite, which at first was good, or even excessive, especially for tasty and fatty food, becomes less and less, in proportion as the taste for drink increases. Inflammation and ulceration of the stomach may arise from other causes, and then will be aggravated by the Alcohol.
Dysphagia, arising from spasms in the pharynx and oesophagus, is not uncommon; at first the attacks are periodical, finally, they become constitutional, and may lead to contraction of the oesophagus. – J.C.P.
According to Orfila, if a large quantity of Alcohol be taken during or shortly after a meal, it coagulates the albuminous portions of the contents of the stomach, and this coagulated albumen passes off almost unchanged into the small intestines. The action of the gastric juice upon the other constituents of the food is prevented, and they undergo acetous fermentation. Hence, as Alcohol prevents the digestion of albumen, it may prevent tuberculosis. – J.C.P.
In Peter’s cases, the stomach presented various appearances. In some drunkards the mucous membrane is perfectly white, but some- what thickened, with distinct flat mamellonated elevations of small size. My friend, Professor Middleton Goldsmith, was one of the first to call attention to the fact that, when a large quantity of undiluted spirits had been taken shortly before death the stomach was often found wrinkled, as if from the action of a powerful astringent; the tops of the rugae or wrinkles presented a punctated and vivid-rod appearance, while the depressions between them were blanched, as if from the action of Alcohol, and the whole mucous membrane was coated with a thick layer of white and very tenacious mucus. In other instances, there were thickening and mamellonation of the mucous membrane, with patches of slate-grey chronic inflammation, upon which spots of punctated, starlike, or diffused haemorrhagic effusion had supervened. In ten or twelve of the worst cases, in which from three pints to two quarts of liquor had been swallowed, within thirty-six or forty-eight hours before death, we found extensive haemorrhagic effusion in a larger portion of the walls of the stomach, with exudation of blood in large patches under the mucous membrane. – J.C.P.
In Ogston’s cases, the stomach was usually small or atrophied in sixteen; highly congested in ten; false melanosis in two; softening of the mucous membrane in two; hour-glass contraction in five; unusual thickening or hypertrophy in one; covered with copious muco-purulent secretion in one.
Ogston places much stress upon the unusually small size of the stomach, altogether different from any mere state of emptiness or natural contraction of the organ; in short, he regards it as such an atrophy of the whole stomach as that viscus might have presented had its growth been arrested in early life. Thus, in one case, the stomach was only half the ordinary size; in a second, it was not larger than that of an infant at birth; in a third, it barely exceeded the diameter of the duodenum over the greater part of its extent; and in the remainder it was unusually or remarkably small as compared with the rest of the intestinal tube.
I feel confident, that there was no actual atrophy in many of these cases. I have seen many cases in which a large quantity of pure spirits had been taken, probably enough to cause death without the aid of other causes, in which the stomach seemed unusually small, from the powerful corrugating action of the Alcohol, but such stomachs could be easily stretched to their natural size. It is true, however, that many habitual drunkards take very little solid food, and hence, as the stomach is very rarely fully distended, it may finally remain almost permanently contracted. – J.C.P.
Alcohol is homoeopathic to many forms of irritation and congestion of the stomach; it is a favorite remedy against dyspepsia from debility; it relieves many forms of nausea and vomiting, and may prove homoeopathic to the morning-vomiting of pregnant women. It is also homoeopathic to acidity of the stomach and water-brash. – J.C.P.
According to our experience, about one dyspeptic in five can take brandy with benefit, provided it is employed in a very dilute form, and is drank during dinner. As a general rule, it will disagree with dyspeptics of a bilious temperament, while those who are nervous or lymphatic will be able to use it with impunity, and, occasionally, with advantage. – J.C.P.
BOWELS.
The small bowels generally partake of the chronic irritation and congestion which obtain in the stomach; but the symptoms do not all arise form chronic inflammation, but from the influence of the altered chyme which comes down from the stomach, altered composition of the bile, imperfection in the nutrition in general, and of the composition of the blood. Hence, after death, the small bowels may appear nearly healthy. But, in higher grades of alcoholismus, there will be more or less difficulty of digestion, colic pains, flatulence, persistent constipation, or alternations with diarrhoea, with putty-like, globular, blackish, or light grey faeces, or constant diarrhoea, with bilious discharges, or like clay dissolved in water, or slimy of bloody matters.
