Symptoms. — The intensity of the symptoms corresponds with that of the functional and organic disorders pro duced. In average cases the earlier symptoms are those indicating nervous disorder, the most important being Inns cular tremor. The hands are unsteady and shake; but, in the majority of care fully examined cases, the lower limbs are found to be affected before the upper (particularly in females). The trouble is especially marked in the morning, and may be such as to render the use of the limbs difficult. At first an effort of the will enables the patient to control the movements of his hands and feet, but this power gradually wanes.
Restlessness, the limbs starting invol untarily, especially after retiring, is the first indication of trouble in some tipplers. The mind becomes irri table; there is headache, dizziness, tin nails aurium and muscte volitantes, while flashes of light are frequently complained of.
Besides the irritability there is usually mental disquietude, the patient being unable to settle down to his duties. He frequently labors under the apprehen sion that bodily harm is awaiting him, whether through the act of some enemy, an accident, or illness he cannot tell. In walking he experiences at times the sensation of falling down a precipice: a bad omen, according to Anstie. As the disease advances the chronic alco holic is apt to become a prey to delu sions of suspicion, while a prominent feature is what may be designated "nar comaniacal untruth," the confirmed sot asseverating that he has drunk no liquor even when seen in the act.
Delusions as to locality are a promi nent symptom in chronic alcoholic men tal derangement. Mason (Quarterly Jour. of Inebriety, July, '92).
Pains around the limbs—especially at the wrists and ankles, the shoulders, along the muscles of the spine, and down the spine proper—are common. These pains are intermittent and par oxysmal, usually appearing late in the day or after prolonged exertion, accord ing to the fatigue to which the patient has been exposed. These neurotic and muscular pains were at one time credited to rheumatism.
[Henry Monro narrated the cure of a number of cases of what he supposed to be alcoholic rheumatism, by the simple withdrawal of alcoholic liquor. The cases were most probably alcoholic multiple neuritis at an early stage. NORMAN KERR.]
Besides the disorders of locomotion attending muscular incoordination, there may be impairment of sensation. The lower limbs are frequently found wasted, while the abdomen is found en larged and, perhaps, pendulous, owing to the presence of adipose tissue. Epi leptiform convulsions are occasionally observed, while mania, melancholia, and dementia are frequent sequelaa.
Gastric disorders may he present early in the history of the case. Nausea and vomiting are common; these usually occur in the morning, and have been known to extend to Immatemesis and death.
Case of profuse and fatal limmatemesis consequent upon chronic alcoholism.
Hancock (Med. Chronicle, May, '91).
The appetite is absent for the break fast in almost all advanced cases; the tongue is coated, and the breath usually very foul. A sensation as if the stomach were sinking is a frequent symptom: an important one in that it usually prompts the patient to drink to obtain temporary relief.
The eyes are congested and watery, the features expressionless. The skin of the face is red and frequently papular: a condition known as "acne rosacea" (q. v.). The latter disease does not occur only in drunkards, however, functional gastric and menstrual disorders being active as etiological factors in perfectly temperate people.
Lindeed, the most aggravated and ob stinate ease of "acne rosacea" which I have ever seen was a merchant whom I have known to have been a strict ab stainer for some fifteen years. NORMAN KERR.) The chronic alcoholism of ardent spirits (whisky, brandy, and gin espe cially) has a distinguishing characteris tic of emaciation with shrunken, though fiery or bluish, countenance, while that of malt intoxicants and sweetish wines (particularly if not alcoholically very strong) exhibits usually a generally bloated appearance, with adipose super abundance.
Differential Diagnosis.—In most cases the alcoholic history, with the symptoms, easily discriminate chronic alcoholism. Among the latter, especially morning nausea, or sickness; foul ethereal breath; furred tongue, eructations, gastralgia and gastrodynia, anorexia, and cephalalgia; diarrhoea or, more generally, constipa tion; tremors, restlessness, fear. In ad vanced stages bloated, puffy, or pinched features; shuffling, ataxic gait; listless ness, perverted sensations, and untruth.