Subacute alcoholism is the ordinary type of drunkenness or and pro duces different manifestations in different in dividuals. The first effect of moderate amounts of alcohol is to cause exhilaration, garrulity, in distinctness and incoherency of speech, blunt ing of the sense of touch, and loss of muscular control so that the patient is unsteady on his feet and staggers when he walks. Dizziness and disturbances of sight and hearing may also appear, and finally a deep lethargy and stupor supervene. On awaking, nausea, vomiting, headache and mental depression remind the sufferer of his debauch. In some individuals the stage of hilarity does not appear and quar relsomeness and moroseness are manifested from the start. The insensibility of alcoholic intoxication to some extent resembles that at tending certain grave disorders like apoplexy, epileptic coma, fracture of the skull or opium poisoning, and mistakes in diagnosis on per sons found unconscious in the street are un fortunately not infrequent. The true state of affairs is often extremely difficult to recog nize, and it is always wiser to treat doubtful cases as if the more serious trouble existed. The fact that the breath smells of liquor is of little value, as bystanders may have sought to aid a victim of other conditions in this way, or a man who has indulged in alcohol may also be suffering from some of the difficulties men tioned. Some persons instead of becoming stuporous pass into a condition of wild excite ment and uncontrollable fury termed alcoholic mania, during which the most revolting crimes may be committed. In others convulsive seiz ures, or alcoholic epilepsy, may succeed the first stage. Dipsomania is a form of mental disturbance in which the patient is subject to attacks of irresistible craving for liquor, though in the intervals he may be quite rational and alcoholic beverages may even be repugnant to him. It is most frequently a manifestation of a compulsive neurosis, or a mild manic-de pression psychosis. Delirium tremens is a state of nervous unrest sometimes following a pro tracted debauch, sometimes appearing in steady, but not necessarily excessive, drinkers, usually as the result of some physical or mental shock. There are distaste for food, intense restless ness, terrifying hallucinations and illusions and obstinate insomnia. The treatment of acute
alcoholism comprises, first, elimination of the poison by washing out the stomach, purging, rectal irrigation with salt solution, and the Turkish bath; and secondly, the substitution of other stimulants such as ammonia, strychnine, caffeine, etc., until nourishment can be retained and strength returns. In delirium tremens the two great indications are to produce sleep and nourish the patient, problems that often tax the ingenuity of the physician to the utmost.
Chronic alcoholism is the result of long continued immoderate indulgence in alcoholic liquors and is a serious cause of disease. It is always due to mental causes. Nearly all the organs of the body are affected and exhibit a new growth of connective tissue. The blood vessels show the lesions of arterio-sclerosis, the heart is affected in a variety of ways, com monly becoming fatty and weak, the kidneys develop nephritis, the liver cirrhosis, and the stomach is the seat of a chronic catarrhal condi tion giving rise to nausea, vomiting and dis taste for food. There are congestive and catarrhal changes in the respiratory apparatus; the bodily strength is decreased and there is a tendency to obesity. There is also marked in volvement of the nervous system leading to complete mental and moral deterioration with loss of will power, loss of memory and inca pacity for the responsibilities of life. Chronic alcoholics have lessened power of resistance to infectious diseases and readily break down under the stress of any mental or physical strain. The treatment of chronic alcoholism requires isolation of the patient, preferably in i - an institution. Some authorities advise m mediate withdrawal of all alcohol, others recom mend a more gradual process of "tapering off." Which method is preferable depends on the in dividual case. Hypodermic injections of nitrate of strychnine form the basis of some of the courses of treatment. The use of atropine, physostigmine, pilocarpine, as drugs which con trol .the disturbance of balance in the vegeta tive nervous system, which is characteristic in chronic alcoholic states, is advisable. (See