COHOLIC DELIRIUM, delirium tremens; ACUTE ALCOHOLIC MANIA, mania a potn; and CHRONIC ALCOHOLISM, the meaning of which has already been Acute Alcoholic Intoxication.
stages are discern ible in tins condition. The first is vas cular relaxation, when the intoxicated is usually lively, merry, agile, and joy ous; all excitement and energy; in the highest spirits, cheerful, hopeful, and communicative; mercurial and confid ing, often telling his private affairs to strangers. There is a warm glow of color on his countenance, he looks at his best. Gradually his spirits rise still higher; he becomes more demonstrative in love or in argument, more emphatic in his gestures, more furious in his fun, and very much louder in his laughter, as the second stage is ushered in. With this he is becoming much less reasonable and amenable, incoherence of thought and speech gradually set in, the imagina tion revels, exaggeration is a prominent feature, and his emotions dominate him, intellect, reason, will, and conscience rapidly fading in the background. In some cases his thoughts, speech, and actions are exaggerated. In other eases these are transformed, the usually modest, retiring man becoming a boaster and a braggart, the truthful a liar, the meek violent. With all this, speech thickens, the lower and then the upper limbs cease to act in unison, the intoxi cated cannot stand, hut staggers with paralytic drunken unsteadiness of gait, the muscles becoming flabby and feeble. The third stage of "dead drunkenness" reveals an unconsciousness with the pallor of apparent death on the face, extreme coldness. accompanied by total insensibility and an utter disregard of the "world without" and the "world within." Sensation, perception, volition, and emotion, all are absent. Through this living death in the heart and cir culation lingers the only spark of vitality which keeps the unconscious drunkard just alive till the faculties, if they do emerge, have emerged from the depth of narcotism into which they were plunged. In some cases the first pleasurable stage and the second, less pleasant, may vary in intensity and duration, hut the last insensible stage usually lasts from six to twelve hours. These successive groups
of symptoms, or stages, may be described as "the three acts of the drama of in toxication." Alcoholic acute poisoning is some times manifested as epileptic explosions. These are, in some cases, with a known epileptic neurosis, the indirect effect of alcoholic provocation; but there are other eases in acute alcoholic excitation seems to directly, after a cer tain quantity of poison has been taken, set up epileptic seizures (these seizures appearing only after the ingestion of alcohol), in which cases no epileptic at tacks or tendencies are ever observed so long as alcohol is not drunk. Purely hysterical paroxysms are also excited in some cases by the consumption of even small doses. Some of the subjects so apt to be toxically affected in this way never display hysterical symptoms at other times.
the toxic action of alcohol in the causation of alcoholic in toxication is the same in kind, all kinds of alcohols being poisonous, the toxic action is modified, in a minor degree (1) by the variety of the alcohol; (2) by the idiosyncrasy of the drinker. The heavier and less highly rectified spirits (aulvlic and butylic) are more toxic than the lighter (ethylic and methylic). Spirits are more acutely toxic than equal quantities of wines and beers, from the greater concentration and quantity of the alcohol in the former, tending more intensely to acute congestion and irrita tion of the gastric mucous membrane, the liver, kidney, heart, and brain. Absinthe induces epileptic convulsions; and meth ylism is much more rapid in its course than ethylic alcohol. The temperament and constitution of the drinker also oc casion some difference of symptoms, one subject getting drunk at once "in the legs," another "in the tongue." In dogs wine-alcohol produces depres sion and inebriety lasting four to five hours; beet-root alcohol, comatose sleep and ancesthesia lasting twenty-four hours, followed by illness; maize-alco hol, the same plus subsultus tendinum. Magnan (Le Bull. Med., July 31, '95).