ALCOHOL 629

The patient suffers from loss of appetite, nausea, vomiting, especially in
the morning, purging, jaundice, tremor of the tongue and hands, insomnia,
loss of memory, impaired power of judgment, dropsy and general annsarea.
The symptoms of peripheral neuritis and dementia supervene in the last
stage. Such patients generally die suddenly from coma.

Treatment.—Ordinarily it is difficult for an addict to give up the habit
of taking alcohol, but antabuse (tetra-ethylthiuram disulphide) is helpful in
weaning him from his habit. Usually this drug does not cause any discom-
fort, but when even a small quantity of alcohol is taken at the same time,
the two drugs combine to form aeetaldehyde, which gives rise to unpleasant
symptoms, such as nausea and vomiting, The addict thus acquires a distaste
for alcohol which may last for several days. Antabuse is administered in
doses of 0.25 to 0,75 Gm. and may be increased to 2 Gms. in a day. A com-
plete psychiatric examination and the treatment of conditions such as manic-
depressive reactions, schizophrenic senile, or arteriosclerotic psychosis be
adequately given if found, A well-balanced diet with large doses of
multi-vitamins should be given for months-

Post-mortem Appearances.—The gastric mucous membrane shows gene-
rally a deep reddish-brown colour with patches of congestion or effusion and
is hypertrophied, The liver is congested and shows fatty infiltration, It is
enlarged or cirrhosed and contracted The kidneys are in a state of granular-
degeneration. The heart is dilated and shows fatty degeneration,

Delirium Tremens,—The chief important condition from a toxicological
point of view is delirium trcmcns, wnich results from the long continued
action of the poison.on the brain* A temporary excess in the case of habitual
drunkards i$ liable to bring on an attack. It sometimes develops in conso-
quence of the sudden withdrawal of alcohol, It also occurs in chronic
alcoholics suffering from shock after receiving an injury, such as the fracture
of a bone, or from acute disease^ such as pneumonia, influenza* erysipelas, etc,

• This condition is characterised by disorientation an to time and place and
a peculiar kind of delirium of horrors owing to hallucinations of sight and
hearing. The patient imagines that rat$> mice and snakes are crawling on his
bed. The patient gets a good deal of muscular tremors, suffers from rest-
lessness, loss of memory and insomnia and has a tendency to commit suicide,
homicide or violent assault or to cause damage to property, Hence he has
to be watched closely and carefully clay and night.

Delirium tromcns is considered unsoundness of mind, and not intoxi-
cation,

Treatment*—Hospitalisation and good nursing is essential To calm
patient give 3 to 5 grains of PentotEal Sodium intravenously f then give
intravenously by drip method 1,000 cc* of a 10 per cent glucose in normal
saline with 15 units of Insulin, 1,000 mg* of Vitamin C, 200 mg, of Vitamin
Bi and 200 mg. of niacinamlde This may be given morning and evening
till the patient is able to take food by mouth. Patient may be given 5 grains
of Lumia*! .fe^isBBL intramuscularly at bed time. Intramuscular injection
of 5 to 8 cc, f*aralaehyde or J to 1 fluid ounce per rectum is also good.
If necessary, give hypodermieally 1/200 gr. of hyoscine hydrobromlde. One-
twentieth grain of apomorphine hydrochloride may be given with caution.
The value of the use of A C T H and Cortisone is yet to be established,

Chemical Analysis.—Alcohol can be extracted by distillation from ant,
organic mixture* If the organic mixture is highly acid* sodium carbonate;
should be added to neutralize it.

Tests*—1* lodoform T#st—A few drops of a strong aqueous .solution of
iodine in potassium iodide are added to a little of the distillate in a test tube