Intoxication (temporary disorder of the body's functions,)

INTOXICATION, temporary disorder of the body's functions, especially of the nervous system (psyche) under the action of so-called narcotic substances (see). Common to various types of I. is the usual presence of two phases: stages of excitation and stages of inhibition. While having common features, I. by different substances has its specific characteristics (see Morphine, Hashish, Cocaine, etc.). The greatest practical significance is alcoholic I., the diagnosis of which (establishing the 'degree of intoxication') often presents considerable difficulties for the physician, especially in mild I. Meanwhile, it is precisely 'mild' I. that has important significance in production, transportation (drivers), etc., as it occurs more frequently and is difficult to subject to medical and technical control. At the same time, the complexity of modern production processes, mechanization of industry and transportation require from the worker not so much the application of physical strength as tension of attention, reasoning, memory, etc., and these abilities are disrupted by even the smallest doses of alcohol (starting from 10 cm⁸ of absolute alcohol), which has been proven by the works of Kraepelin, W. Miles, Vernon, Aschaffenburg, etc. In connection with this, the very concept of 'drunk' has undergone evolution. According to the definition of Stewart (Stewart), 'a drunk is any person who has taken alcohol in sufficient quantity to poison his central nervous system to such an extent that the normal processes of reaction to the surroundings are temporarily disrupted and the person becomes a burden or presents a danger to himself or others.' In the diagnosis of alcoholic I., the following abilities are examined: first, the state of intellect-narrative, conversation with the subject, his reaction to the surroundings, state of memory, orientation in place and time, etc.; of course, the emotional state of the subject (excitement, fear), his education, natural mental abilities, have great significance here. Further, the so-called 'fine' movements are examined: speech, writing, ability to pick up a coin from the floor, walk in a straight line, turn quickly, etc.; the symptom of Romberg is little applicable here; in examining motor function, it is necessary to exclude the possibility of organic and functional diseases of the nervous system. Examination of reflexes has no serious significance, as their absence or strong inhibition occurs only in severe degrees of I. (here, of course, tabes must be excluded); however, an increase in tendon reflexes gives nothing for diagnosis. The state of the pupils is also not characteristic of alcoholic intoxication: special studies (Feiling and others) indicate contradictory results even in alcoholic coma-in some poisoned individuals the pupils are found dilated, in others-sharply constricted. The reflex immobility of the pupils in intoxicated individuals is often observed, however this sign is not sufficiently persistent. Some significance has the symptom of Macewen and Glaister, consisting in that the constricted pupils of a drunk person dilate with painful stimulation and then quickly narrow again. From the side of the gastrointestinal tract, the most important symptom is the odor from the mouth (which, however, can easily be disguised), further a coated tongue, vomiting, especially with subsequent rapid improvement in condition. From the side of the cardiovascular system, redness of the face, conjunctiva, accelerated pulse, etc., are observed. Increased diuresis is often observed. In general, there are no reliable, fully specific symptoms of alcoholic I., and in establishing the degree of I., the physician has to take into account the entire sum of signs, guided by practical experience, which often leads to misunderstandings and errors in diagnosis. Great significance in the picture of I. is the individual endurance of the subject: in psychopaths, traumatized individuals, organics-epileptics, neurasthenics, a sharp reaction is often observed with small doses of alcohol, up to pathological I. Characteristic signs of the latter are: the discrepancy between the psychic reaction to the relatively small amount of alcohol consumed; sharp disturbance of psychic processes, especially of perception and evaluation of external impressions, with relative preservation of physical abilities; abrupt onset of pathological I. and often its excessive duration; amnesia regarding what happened after the cessation of I. The following types of pathological I. are distinguished: 1. Epileptoid pathological I. with significant psychomotor excitation, tendency toward aggressiveness, violence, sharp disturbance of the affective sphere (fear, anger); the course is usually prolonged with subsequent deep sleep and amnesia; often accompanied by convulsions (ivresse convulsive), involuntary urination, etc. This form of I., which has serious criminal significance (ivresse suicide), is most often observed in epileptics, epileptoid psychopaths, and individuals with corresponding hereditary predisposition. 2. Delirious pathological I. is usually observed in chronic alcoholics, psychopaths-besides the usual symptoms of pathological I., there are present fears and hallucinations, usually of a terrifying nature (visual and auditory). Unlike delirium tremens, all these symptoms disappear with the passing of I. (not later than a day). 3. Twilight states of alcoholics (Moeli), ambulatory automatism of alcoholics (Beard), provoked by small doses of alcohol, in which intoxicated individuals sometimes commit a series of externally purposeful, but essentially absurd, unmotivated actions (as in epileptic and hysteric twilight states, for example, they travel to another city, where, 'coming to themselves,' they are surprised how they got there, etc.). 4. Psychoid pathological I., in which the picture of intoxication acquires a specific coloring in connection with the psychotic predisposition of the subject (not mentally ill), for example, the manifestation of schizophrenic symptoms (delusions of influence, hypnosis, olfactory hallucinations, etc.) in schizoid psychopaths with schizophrenic heredity. Except in cases of pathological I., there is a certain dependence between the degree of I. and the amount of alcohol consumed, as well as the distribution of alcohol within the body. Being absorbed, alcohol spreads approximately uniformly in all tissues and organs, reaching maximum concentration after 1¹/₂-3 hours. In chronic alcoholics, due to more energetic absorption and oxidation, maximum concentration occurs significantly earlier (according to Schweisheimer twice as fast) and traces of alcohol disappear also sooner. On average, the human body oxidizes 7-12 cm³ of absolute alcohol per hour (Kraepelin); during work, oxidation occurs faster than in a state of rest. If we take the concentration of alcohol in the blood of a drunk person as a unit, then its concentration in urine will be 1.35, in cerebrospinal fluid-1.45, in the liver-1.5, in the brain-1.75. The connection between the amount of alcohol introduced and the body's reaction was established by the works of Nicloux, Schweisheimer, Balthazard, Rapoport, etc. in the following form. 1. The amount of alcohol consumed is proportional to the alcohol content in the blood. 2. The maximum content of alcohol in 1 cm³ per 1 liter of blood of an animal equals the number of cm³ of pure alcohol consumed per 1 kg of the animal's weight. 3. The proportion of 0.5-1 cm³ of absolute alcohol per 1 liter of blood is insufficient to cause externally detectable I. This proportion is achieved when introducing into the animal's organism 0.5 cm³ of alcohol per each kilogram of its weight (mild I.). The average degree of I. corresponds to 2-3 cm³ of alcohol per 1 liter of blood, which is achieved by introducing 2-3 cm³ of alcohol per 1 kg of weight. Deep I. is obtained with an alcohol content of 4-6 cm³ per 1 liter of blood, i.e., when introducing 4-6 cm³ per 1 kg of weight of the animal. Partial anesthesia is obtained with 7 cm³ and complete-with 8,9, 10 cm³ per 1 liter of blood, or 1 kg of weight. Dosis letalis for a person is established at 8-9-10 cm³ per 1 kg of weight (Demmo, Balthazard, etc.). Habituation to alcohol in chronic alcoholics increases their endurance in relation to dosis letalis within not more than 30%. The significance of diuresis in the excretion of alcohol is relatively small-only 1.2-1.6% of the introduced amount (95% is oxidized within the organism). Stronger alcoholic beverages give a higher concentration of alcohol in the body (difference 7v-7z). A serious role in the concentration of alcohol and consequently in the picture of I. is played by the degree of stomach filling with food. Handwerk gave subjects after a large amount of beer (consumed within 45 min.-V₁/₂ hour) a substantial breakfast and found that the effect of the latter manifested in a significant acceleration of alcohol absorption (its maximum concentration in the blood). The curve of alcohol content in the body also fell relatively quickly. The breakfast eaten before starting to drink, however, seemed to have the opposite effect: here the maximum concentration was observed not soon, and the curve of alcohol content fell relatively slowly, accordingly the picture of I. turned out to be not sharply expressed. In practice, a mild degree of I. is obtained when introducing into the human organism not less than 0.5-1 cm³ of alcohol per 1 kg of weight.

For example, if a person weighing 80 kg drinks 200.0 cm³ (a glass) of 40° vodka, i.e. about 80 cm³ of absolute alcohol, then the maximum concentration of alcohol in their blood, which occurs with small doses after 1^st/2-2 hours, will be equal to 1 cm³ of absolute alcohol per 1 liter of blood. Taking into account all the mentioned factors, it appears possible to use chemical methods to establish the fact and degree of intoxication as well, by examining blood, urine, breath, etc. for alcohol concentration. Such studies, previously used mainly by forensic experts, are recently also recommended for forensic psychiatrists, police physicians, insurance physicians, etc. Most chemical research methods are quite complex. For example, the very sensitive method of Wagner and Kionka, which makes it possible to determine alcohol in dilutions up to 0.0001%, requires the use of a complex interferometer instrument and is based on determining the difference in concentration of two liquids, which is achieved by measuring the distance between the interference lines of the test liquid and the control. Most biochemical methods—of Niklu, Widmark, Astruc, Rapoport, Hansen—are based on the fact that alcohol in the presence of sulfuric acid is quickly oxidized and turns into acetaldehyde, which has the ability to break down oxygen compounds. Improvement (simplification) of these methods will make it possible not only to establish the degree of I. but also to organize systematic mass control of sobriety in complex industries, in transport (drivers, locomotive engineers), by establishing the presence of alcohol in the blood, urine and exhaled air of the subjects. Treatment of acute alcohol intoxication (sobering up) consists of as rapid as possible stomach lavage (watch the heart activity), injections of camphor and caffeine. Large amounts of liquid (milk) are given in combination with diuretics. For headache and clouding of consciousness, large doses of pyramidon with caffeine help. For sedation—baths; for cyanosis—oxygen; for pathological I.—sleeping pills, baths, bed rest, careful supervision; for prolonged epileptoid pathological I., placement in a psychiatric institution is best. Wrapping is undesirable due to the danger of overheating and cardiac failure. For the treatment of acute alcohol poisoning, in recent years in major centers of the USSR, special sobering-up stations (narcotic reception centers) have been organized. Thus, in most districts of Moscow, narcotic reception centers function for severe forms of I. (among workers, not recidivists). Along with providing appropriate medical assistance, a system of fines is applied depending on the earnings of the person being sobered up, for which a police supervisor is on duty at the narcotic reception center. In a number of narcotic reception centers, beds have also been set up for short-term hospitalization (3-5 days) of alcoholics who, due to their condition, cannot be immediately discharged after sobering up (binge, severe abstinence, physical weakness, etc.). On the effect of I. on labor productivity, injuries, crime, offspring—see Alcoholism.

For applications, see technical manuals on microscopic technique.