Of all alcoholic drinks the most dan gerous are the liquors containing essen tial oils, such as the various absinthes and anisettes. The least harmful are those made without essential oils— from chemically-pure industrial alcohol, brandy, bitters, etc.—by means of non toxic ilavoritar materials. For an iden tical proportion of alcohol, wines are more toxic than wine-brandies, which, in turn, are more toxic than brandies artificially prepared by means of well rectified commercial alcohol. Generally white wines are less toxic than red wines. Wines treated with plaster and diseased wines are exceedingly toxic. Experi ments made by means of intravenous in jections in rabbits demonstrating the above. Daremberg (Archives de AIM. Exp6r., vol. p. 6, '9.5).
Drinking habits existed in one or both parents in all of 350 eases examined ex cepting 10. The father was usually the drinker. In another series of 210 eases the percentage was much lower: 25 per cent. gave a negative hereditary history. Mechanics, artisans, and small trades men furnish the greatest proportion of cases, the in-door workman being often est the victim. About one-third of in ebriates are women. C. L. Dana (Med. Record, July 27, I90I).
Pathology. Post-mortem Appearances.
a fatal case seen by me, of a mar ried woman, aged 41, who had died without. recovering consciousness in hours after swallowing at a draught 2 pints of whisky, the face was pale, the eyes suffused and dull with dilated pupils, the temperature 91° F.; the pulse was thin, compressible, and barely per ceptible; the breathing stertorous, the skin cold and clammy. There are some times also congestion of the liver, cere bral congestion with ventricular serous effusion, and distension of right heart cavities with semifluid blood. In another case, that of a man who was found dead after a drinking-bout„ the mucous mem brane of the stomach was so inflamed and angry, with patches of a deeper hue extending over the pyloric surface to the duodenum, and a grumous, slightly muco-purulent exudation from bleeding points, that arsenical poisoning was sus pected. Tardieu in one case found pulmonary apoplectic extravasations of blood.
The first pathological stage of intoxi cation is one of vascular relaxation, with vasomotor paralysis and reduced inhi bition; the second, one of continued inhibitory reduction, with incomplete partial paralysis of the brain- and nerve centres, with intellectual automatism, ' accompanied by loss of co-ordination.
The third stage is one of advanced pa ralysis, for the moment complete, with ' automatic existence and the reduction of temperature by 3 to 7' or more degrees.
Poisoning with alcohol in considerable doses, continued over a moderate time, will produce decided and ascertainable lesions of the nutrient structures and nervous elements of the cerebrum, very similar in character to the pathological lesions produced by other more virulent soluble poisons. Henry J. Berkley (Johns Hopkins Hosp. Reports, vol. vi. '97).
Differential Diagnosis. — In the first two stages, the exhilarative and the preliminary automatic, simple nerve ex citement, opiate or other narcotic excita tion, and apoplexy may simulate the symptoms of alcoholic intoxication; but the non-alcoholic rapidly subside, the apoplectic either passing off or going on quickly to coma. Usually the history or the surroundings reveal the presence of alcohol.
In the last, or third, stage of alcoholic insensibility the difficulties are much greater. The breath may smell of liquor, but that alone is not a safe guide; I have known abstainers taken to a police-cell, owing to some bystander having poured brandy down the throat of the uncon scious nephalist. Apart from a history of drinking, only withdrawal of alcohol from the stomach can prove an alcoholic origin. It has been asserted that press ure on the supra-orbital notches, thereby compressing the nerve, will elicit signs of life in the alcoholized.
COMA.—The comatose state of diabetes and albuminuria (in urmraia there may be albuminuric retinitis with normal or enlarged pupils) may be differentiated by a urinary analysis, though it must be remembered that both of these condi tions may exist with alcoholism, and also with the odor of acetone from the breath. The renewal of the alcoholic symptoms by inhalation of the vapor of ammonia has been suggested by Waters.