A large quantity of pure Alcohol also reaches the duodenum, mixes with the bile, which loses its alkaline properties, and can no longer be precipitated into insoluble flocculi by the addition of the acid chyme, as is normally the case; in the natural state, this insoluble precipitate from the bile is not reabsorbed, but is cast out of the body with the faeces; in drunkards, however, no such precipitate ensues, the bile remains fluid and unchanged by the chyme, and a large portion of it is reabsorbed. Hence the bilious disorders in topers, and the frequent occurrence of jaundice. Large quantities of acid chyme and imperfectly digested food pass along the small intestines, and even reach the coecum and colon, when they also undergo a farther acetous fermentation. Hence the sour eructations, colic from acidity, irritation and flatulence, and the dyspeptic troubles of drunkards.
The small bowels, in Peters’ cases, were literally filled with bile, and their mucous membrane thickly coated with a very tenacious mucus. In eight or ten of the worst cases, numerous and extensive patches of haemorrhagic effusion were found, with copious exudation of blood in and beneath the mucous membrane. – J.C.P.
Ogston found unusual contraction of the intestines in six cases, softening of the mucous coat in two; enormous distention in two; atrophy in one case, the bowel being attenuated and translucent; congestion of the duodenum in one.
It is quite homoeopathic in diarrhoeas proceeding from an atonic condition of the mucous membrane of the intestine, and from chronic inflammations of this structure. It likewise proves curative in diarrhoea caused by slight irritation of the mucous coat, in consequence of colds, improper food,
OMENTUM.
The appearance of this organ was generally very peculiar; it was usually equally filled with an ashy-grey slushy fat, but no large masses or lumps of fat were met with. Our attention was first called to this sign in Vienna; it is there regarded as so characteristic that a cadaver was often judged to be that of a confirmed drunkard, from a glance at the omentum when the abdomen is first laid open. – J.C.P.
In Ogston’s cases, the omentum was loaded with fat in four, coincident in all with abundant subcutaneous fat; in two with fat around the heart; in one with conversion of the vermiform appendages into large fatty masses.
MESENTERY.
This was always loaded with a thick layer of whitish yellow fat.
LIVER AND PORTAL SYSTEM.
Alcohol rarely or never causes acute inflammation of the liver in temperate climates; but it often causes congestion, attended with jaundice; also enlargement.
The blood which returns from the intestines into the portal- system and liver is more or less mixed with Alcohol, imperfect bile, and other undigested and impure matters; hence the abdominal venous plethora and subsequent affections of the liver. As much bile is returned to the liver, it is doubtless resecreted from it again with great rapidity; hence, among other causes, the large quantity of bile which is usually found in the gall-bladder and small bowels. Abdominal dropsy only occurs in drunkards after the liver has been diseased, indurated, or granulated for a long time. It is apt to remain isolated, or unassociated with general dropsy; even the feet and legs are not apt to swell. The contrast between the distended abdomen and emaciated extremities is very striking in this form of dropsy.
In Peters’ cases the liver in moderate drinkers was found a little larger than natural, somewhat softened, and its external surface dotted with whitish patches of fatty infiltration, which extended but two or three lines into the parenchyma; the color of the rest of the organ was of a rather darker red than natural, and the edges retained their normal sharpness. In excessive drinkers the liver was considerably larger, the edges more obtuse, and the patches of fat larger and more numerous. In old habitual drunkards the liver was very large, weighing at least six or eight pounds, and often ten or twelve; the edges were very thick and much rounded; the parenchyma almost white with fat, soft, fragile, and the peritoneal covering could be torn off in large pieces with great ease. Granular liver was found in four or five cases only; and gall-stones only twice. – J.C.P.
Ogston found the liver enlarged in thirty-two cases; granular in fourteen; nutmeg liver in thirteen; fatty liver in twenty-four. cirrhosis was only present in five cases out of one hundred and seventeen.
Alcohol is homoeopathic to enlargement of the liver, fatty condition of this organ, and to the nutmeg and granular liver; also to biliousness and jaundice; and the ascites from disease of the liver. – J.C.P.
SPLEEN.
Although the spleen, in those who die of delirium tremens, is generally enlarged, soft, and brittle, and swells more rapidly and considerably when drunkards are attacked with intermittent fever, still no actual alterations of structure take place during the course of alcoholismus-chronicus, neither are there any symptoms referable to this organ.
In Peters’ cases this organ presented but few characteristic alterations. It generally retained its normal size, but was somewhat congested and softened. Occasionally it was rather larger than natural, but, as a rule, the small size of the spleen contrasted strongly with the very great size of the liver. – In Ogsten’s cases the spleen was indurated or hepatized in ten; enlarged in two; atrophied in one; softened in one. It was softened in fifteen per cent of the cases, and hypertrophied in eighteen per cent.
KIDNEYS.
Pain and sensitiveness in the region of the kidneys are apt to arise after a debauch, when the urine may also contain albumen, or the serum of the blood, owing to a transient but decided congestion. At times the urine also contains the coloring matter of the bile, viz., when there is congestion or chronic disease of the liver; or an excess of phosphates or urates, especially when the liver is indurated; or it may become alkaline when symptoms of paralysis arise. Drunkards are particularly apt to get disease of the kidneys when they are attacked with relapsing fever and ague, or chronic rheumatism.
In Peters’ cases the kidneys were generally somewhat enlarged flabby, their cortical substance infiltrated in numerous small spots, with a whitish, fatty, or albuminous substance; occasionally they were granular; the pelvis and ureters were generally in a state of chronic, slate-grey inflammation. – J.C.P.
In Ogsten’s cases there was general fatty degeneration in one; congestion in four; sometimes coincident with nutmeg liver and albuminous urine; enlarged in thirteen; atrophied in one; buff- colored, with atrophy of the cortical portion in four; with albuminous urine in five.
BLADDER.
In Peters’ cases the bladder generally presented no unusual appearance; but in four or five of the worst cases there was a state of haemorrhagic exudation, which rivalled in extent and severity that which has already been described as occurring in the stomach and bowels. When drunkards become weak or partially paralytic, the bladder will partake of the debility of the rest of the system. – J.C.P.
In retention of urine from paralysis of the bladder, bathing the hypogastric region with Alcohol, and allowing it to evaporate, is occasionally useful.
LUNGS.
In Peters’ cases these were generally not much diseased; at least, dyscratic organic disease of them, directly attributable to Alcohol, was not often met with. Congestion of the lungs was very common. Where large quantities of spirits had been taken shortly before death, the lungs were often found in a state of splenization; they appeared perfectly saturated with dark blood, which soon changed to a florid red on exposure to the air, except that which flowed from the large severed vessels, for this remained thick, dark and tar-like. The parenchyma of the lungs was heavy and semi-solid to the feel, and somewhat softened, as the finger could easily be forced through it. The bronchi were almost always found reddened, somewhat dilated, and more or less filled with catarrhal secretions. Dr. Peters feels obliged to call particular attention to the infrequency of phthisis in drunkards; in the seventy cases, he never met with a tubercular abscess, even of the smallest size, while a small number of chalky or obsolete tubercles was frequently noticed; and cicatrices were also occasionally found, marked by the presence of puckering of the surface of the lungs; of solid lumps or stripes, which were readily felt before the lung was cut into, and, when this was done, they were found to consist of masses or stripes of callus fibrous tissue, around which were rarely discovered a few discrete, grey, crude, small, tubercular granulations. In every instance, these appearances were strictly confined to the upper third of the superior lobes, and all the rest of the lungs was entirely free from either recent or old tubercular disease. – J.C.P.
Ogsten also says that, so far as his one hundred and seventeen cases go, his observations bear out the correctness of now commonly-received opinion as to the comparative immunity of drunkards from tubercular affections.
