Chronic alcoholism. I shall not attempt to discuss the social and economic evils of this disease; it is universally condemned, while being universally talked about. But unlike the weather, something is being done about it.
A. The brain: The changes in this organ are often those related to vitamin B and C deficiencies. Hemorrhages frequently are found throughout the cerebral tissue in chronic alcoholism. The brain is particularly susceptible to injuries, such as a blow on the head. Rupture of the blood vessels with subsequent death is a frequent close to an alcoholic bout where the victim has been lodged in the "drunk tank" overnight at the local jail, and has either fallen on his head or sustained a knock on his "noggin."
B. Wernicke's disease. Back in 1881, Dr. C. Wernicke in Germany first described three alcoholic patients with paralysis of the eye muscles, uncoordinated walk, clouding of the consciousness and finally, coma. Such cases are caused by a destruction of certain brain tissue and are common. I have had this kind of patient during my ward service in Philadelphia and Los Angeles County General Hospitals.
C. Marchiafava-Bignani's disease. This is a rather unusual disorder, occurring only in those who drink the common Italian red wine without proper food intake and is seen especially in Italy. Destruction of the brain tissue here is also characteristic, the patient usually being excited, confused, and finally psychotic.
D. Delirium Tremens. This interesting condition was first described in 1813 by Sir Thomas Sutton and is associated with a "wet brain." An alcoholic complication that is very frequent, it is characterized by confusion, anxiety or terror, auditory and visual hallucinations, and delusions.
Some patients I have seen and treated for this disorder are obsessed with snakes, others with animals, and still others with people following, watching, or persecuting them. Violent tremors and shaking frequently join with delirious episodes in this devastating form of alcoholic disease. I shall never forget an experience during my internship days with an alcoholic suffering from delirium tremens. He was in terror of the usual "pink elephant," animals, and insects crawling all around him, the walls of his room, and on his own body. This unfortunate man had lost his business and his wife and children. They had to leave him because of his abnormal behaviour and his chronic alcoholism. He had become psychotic, shook like a leaf, and now had severe hallucinations. When my "chief (the attending physican) and I entered his room at the hospital together with the floor nurse, the patient was lying quietly in bed. He looked up at us and let out a blood-curdling scream. He leaped out of bed, seized the necktie around his physician's neck and tried to yank it off, strangling the doctor in the process and letting out a salvo of piercing shrieks strong enough to awaken the dead. After we had wrestled him free and sedated him, it came out that he had imagined the doctor's necktie to be a snake. He had only attempted to yank it free and had heroically tried to save the doctor's life! The realism of these hallucinations to the patient with D.T.'s is pathetic, and their terror and suffering tragic to see.
E. Polyneuritis. This most frequent complication of chronic alcoholism is caused specifically by changes or destruction, in the peripheral nerves of the body due to lack of vitamin B. The feet are usually numb, tender, or painful and frequently paralyzed so that walking may become impossible. This is called "foot drop," and is often associated with other complications of chronic alcoholism.
F. Korsakoffs Psychosis. This disease is also believed to result from a vitamin deficiency and is a most curious one. The patient is highly suggestible to any idea and is completely with out any judgment regarding its credibility. He tells incredible stories that outdo Baron Munchausen; he can imagine the tallest of tall tales. One case of this bizarre condition that stands out in my memory is that of a waiter whom I took care of some 25 years ago. He had been a chronic alcoholic for many years and was installed in the psychiatric ward for observation and commitment. One day, during my ward rounds, he informed me that he had just learned I was leaving for London, on a fellowship in medicine and wished me good luck. Then to my surprise he discussed and advised me in the greatest detail imaginable about many of the hotels in London and their advantages and disadvantages for an American. He knew with the knowledge of a connoisseur the virtues of certain restaurants and pubs, transportation facilities, entertainment spots. He reminisced fondly over many enjoyable hours and delightful memories of his life in London. And yet his family assured me with utter finality that he had never left the United States, and was never seen to read a book! In the case of this psychotic patient, it was his extraordinary imagination that gave to his stories the ring of conviction and truth. I finally discovered that this patient had worked for years with a bartender at a restaurant. During slow periods many an hour was passed drinking with this bartender, a "Cockney" who regaled my patient with endless reminiscences of his life and experiences in London. But the patient, who was exceedingly suggestible (like many normal individuals under hypnosis), believed completely that he himself had lived through these past experiences of another person.
What does alcohol do to the liver?
Cirrhosis of the liver is a sequel to chronic alcoholism. It is basically a nutritional disease, brought on by inadequate and improper diet coupled with excessive alcoholic intake. In this disease, the liver is usually swollen and enlarged at first, but later it becomes small, shrunken, and atrophied. It is accompanied by a series of signs and symptoms that are characteristic. These range from nervousness, fatigue, dyspepsia, vomiting and passage of blood, chest and abdominal pains and swelling, to jaundice, coma, and death. Some years ago I introduced a program of treatment for this condition based on a high protein diet, nutritional and vitamin supplements, and certain injections of liver and vitamins. I reported in various medical journals the results of this temporarily effective treatment for over 100 cases with this disease, and it was used extensively by physicians in the country and abroad. Psychiatric care did not help in 95 per cent of the cases I have described.However, Alcoholics Anonymous was a tremendous help in at least half of them, a striking demonstration of the value of group psychotherapy and a blessing to countless unfortunate victims. Moderation in drinking alcohol is a term with very wide latitude. Some people have only to take the proverbial whiff from the cork of a whiskey bottle, and they already feel 'giddy.' Others seem to have the 'hollow wooden leg,' and feel no effects from alcohol unless they have had 5 or 10 times the amount required by the average person to feel their drink. Usually, an average of one or two highballs or cocktails, or glasses of wine or beer, once or twice a day is regarded as drinking in moderation. The main thing to remember is that drinking is not to be indulged in to the point of excess, where intoxication occurs, or where the critical judgment, the physical or mental faculties are in the least way impaired or interfered with.
What are the conclusions for you? What are the conclusions to be gained from all the descriptions of these "medical chambers of horrors"? Simply that drinking alcoholic beverages in moderation is a great help to relax you, to put you at ease from your cares and worries; and in general it is good for your circulation. If you find that you cannot stop at "moderation," then before it's too late don't touch it again! And if it is too late for that, then see your doctor for further help, and join Alcoholics Anonymous!
