140 MATER i A MEDIC A AND THERAPEUTICS. 



depression, which spreads, like the excitement, from the highest 

 to the lowest centres of the brain and cord. The intellectual, 

 emotional, and voluntary faculties become first inco-ordinated, 

 then dull, and finally completely arrested ; the muscles are 

 first ataxic and next paralysed, so that after an unsteady, stag- 

 gering gait, the erect posture is impossible ; and the consequent 

 depression of the respiratory and circulatory centres leads to 

 stertorous breathing, circulatory failure, and even death. 

 The effects of alcohol upon the nervous centres are referable 

 partly to dilatation of the blood-vessels of the brain and cord, 

 but certainly also to a direct action of the drug upon the nerve 

 cells. 



The action of alcohol on the other bodily functions is 

 chiefly, if not entirely, indirect. Thus, the muscles are affected 

 solely through the nervous centres and nerves. Respiration is 

 first increased, then slowed and weakened, partly through the 

 special centre, but manifestly also, to a great extent, through 

 the muscles and the circulation. Death occurs partly by 

 asphyxia. The bodily temperature is, on the whole, lowered 

 by alcohol : (1) by increased circulation through the dilated 

 peripheral vessels; (2) by increased perspiration; (3) by di- 

 minished metabolism ; and (4) after large non-medicinal doses, 

 by general depression. The sense of warmth is, on the con- 

 trary, increased by the flushing of the skin with blood, a condi- 

 tion which promotes bodily heat and comfort in a warm or 

 moderately cool atmosphere, but causes rapid refrigeration, 

 general vital depression, and even death, in low states of the 

 external temperature. 



4. SPECIFIC USES. 



The uses to which the complex specific action of alcohol 

 may be turned are many, and of great importance : 



Alcohol is employed in fever, and other acute wasting 

 diseases, such as delirium tremens, and acute mania. The in- 

 dications in these conditions are to prevent or to make good 

 the great waste of tissues associated with the disease ; to sustain 

 the heart and nervous system, which threaten to fail, as the 

 frequent pulse and the delirium testify; and to promote the 

 loss of heat, which is formed in excess, as indicated by the 

 thermometer, the dry-brown tongue, the sleeplessness, and the 

 general restlessness of the patient. We have seen that these 

 ends are all fulfilled to a certain extent by alcohol. When the 

 symptoms just mentioned appear, brandy or other form of 

 spirit, and wines of the stronger varieties, are given in a definite 

 amount per diem, according to the height of the fever, the 

 state of the pulse and heart sounds, the general strength, tlx> 



