PATHOLOGY OF DRUNKENNESS.
The evil consequences of drinking, both in a physical and moral point
of view, seem to have been known from the most remote antiquity. They
are expressly mentioned in Scripture; nor can there be a doubt that the
Homeric fiction of the companions of Ulysses being turned into swine by
the enchanted cup of Circe, plainly implied the bestial degradation into
which men bring themselves by coming under the dominion of so detestable
a habit. Having mentioned these circumstances in favour of the accuracy
of ancient knowledge, we shall simply proceed to detail the effects
of drunkenness, so far as the medical practitioner is professionally
interested in knowing them. The moral consequences belong more properly
to the legislator and divine, and do not require to be here particularly
considered.
I. _State of the Liver._—One of the most common consequences of
drunkenness is acute inflammation. This may affect any organ, but its
attacks are principally confined to the brain, the stomach, and the
liver. It is unnecessary to enter into any detail of its nature and
treatment. These are precisely the same as when it proceeds from any
other cause. The inflammation of drunkenness is, in a great majority of
cases, chronic; and the viscus which, in nine cases out of ten, suffers,
is the liver.
Liquors, from the earliest ages, have been known to affect this
organ. Probably the story of Prometheus stealing fire from heaven and
animating clay, alluded to the effects of wine upon the human body;
and the punishment of having his liver devoured by a vulture, may be
supposed to refer to the consequences which men draw upon themselves
by over-indulgence—this organ becoming thereby highly diseased. Man is
not the only animal so affected. Swine who are fed on the refuse of
breweries, have their livers enlarged in the same manner. Their other
viscera become also indurated, and their flesh so tough, that unless
killed early, they are unfit to be eaten. Some fowl-dealers in London
are said to mix gin with the food of the birds, by which means they are
fattened, and their livers swelled to a great size. The French manage to
enlarge this organ in geese, by piercing it shortly after the creatures
are fledged.[28]
Neither malt liquors nor wine have so rapid and decided an effect upon
the liver as ardent spirits. Indeed, it is alleged, although I cannot
go this length, that the wine that is _perfectly pure_ does not affect
the liver: and the fact of our continental neighbours being much less
troubled with hepatic complaints than the wine-drinkers among ourselves,
gives some countenance to the allegation; for it is well known that to
suit the British market, the vinous liquors used in this country are
sophisticated with brandy. In wine that is perfectly pure the alcohol
exists in such a state of chemical combination, as greatly to modify its
effects upon the system. In the wine generally to be met with, much of it
exists mechanically or uncombined, and all this portion of spirit acts
precisely in the same manner as if separately used.[29]
The liver is a viscus which, in confirmed topers, never escapes; and it
withstands disease better than any other vital part, except, perhaps, the
spleen. Sometimes, by a slow chronic action, it is enlarged to double
its usual size, and totally disorganized, and yet the person suffers
comparatively little. The disease frequently arises in tropical climates,
from warmth and other natural causes, but an excess in spirituous liquors
is more frequently the cause than is generally imagined.
The consequences which follow chronic inflammation of the liver, are
very extensive. The bile, in general, is not secreted in due quantity or
quality, consequently digestion is defective, the bowels, from want of
their usual stimulus, become torpid. The person gets jaundiced, his skin
becoming yellow, dry, and rough, and the white of his eyes discoloured.
As the enlargement goes on, the free passage of blood in the veins is
impeded, and their extremities throw out lymph: this accumulating,
forms dropsy, a disease with which a great proportion of drunkards are
ultimately more or less affected.
The jaundice of drunkenness is not an original disease, but merely a
symptom of the one under consideration. A very slight cause will often
bring it on; it is, consequently, not always dangerous. Dropsy is, for
the most part, also symptomatic of diseased liver, but sometimes, more
especially in dram-drinkers, it arises from general debility of the
system. In the former case, effusion always takes place in the cavity
of the abdomen. In the latter, there is general anasarca throughout the
body, usually coupled with more or less topical affection. In every
instance, dropsy, whether general or local, is a very dangerous disease.
II. _State of the Stomach, &c._—Like the liver, the stomach is more
subject to chronic than acute inflammation. It is also apt to get
indurated, from long-continued, slow action going on within its
substance. This disease is extremely insidious, frequently proceeding
great lengths before it is discovered. The organ is often thickened
to half an inch, or even an inch; and its different tunics so matted
together that they cannot be separated. The pyloric orifice becomes, in
many cases, contracted. The cardiac may suffer the same disorganization,
and so may the œsophagus; but these are less common, and it must be
admitted, more rapidly fatal. When the stomach is much thickened, it may
sometimes be felt like a hard ball below the left ribs. At this point
there is also a dull uneasy pain, which is augmented upon pressure.
Indigestion or spasm may arise from a mere imperfect action of this
organ, without any disease of its structure; but when organic derangement
takes place, they are constant attendants. In the latter case it is
extremely difficult for any food to remain on the stomach; it is speedily
vomited. What little is retained undergoes a painful fermentation,
which produces sickness and heartburn. There is, at the same time, much
obstinacy in the bowels, and the body becomes emaciated.
This disease, though generally produced by dissipation, originates
sometimes from other causes, and affects the soberest people. Whenever
the stomach is neglected, when acidity is allowed to become habitual, or
indigestible food too much made use of, the foundation may be laid for
slow inflammation, terminating in scirrhus and all its bad consequences.
Vomiting of bilious matter in the mornings, is a very common circumstance
among all classes of drunkards. But there is another kind of vomiting,
much more dangerous, to which they are subject; and that is when
inflammation of the villous coat of the stomach takes place. In such
a state there is not much acute pain, but rather a dull feeling of
uneasiness over the abdomen, attended with the throwing up of a dark,
crude matter, resembling coffee grounds. I have seen two cases in which
the vomiting stopped suddenly, in consequence of metastasis to the head.
In these, the affection soon proved fatal, the persons being seized with
indistinctness of vision, low delirium, and general want of muscular
power: the action of the kidneys was also totally suspended for three
days before death. On examination, _post mortem_, there was effusion in
the ventricles of the brain, besides extensive inflammation along the
inner surface of the upper portion of the alimentary canal.
Bilious complaints, which were formerly in a great measure unknown to the
common people, are now exceedingly common among them, and proceed in a
great measure from the indulgence in ardent spirits to which that class
of society is so much addicted.
There is nothing more indicative of health, than a good appetite for
breakfast; but confirmed topers, from the depraved state of their
stomachs, lose all relish for this meal.
Persons of this description are generally of a costive habit of body, but
a debauch, with those who are constitutionally sober, is, for the most
part, followed by more or less diarrhœa.
In the latter stages of a drunkard’s life, though he has still the relish
for liquor as strongly as ever, he no longer enjoys his former power of
withstanding it. This proceeds from general weakness of the system, and
more particularly of the stomach. This organ gets debilitated, and soon
gives way, while the person is intoxicated much easier, and often vomits
what he had swallowed. His appetite likewise fails; and, to restore it,
he has recourse to various bitters, which only aggravate the matter,
especially as they are in most cases taken under the medium of ardent
spirits. Bitters are often dangerous remedies. When used moderately, and
in cases of weak digestion from natural causes, they frequently produce
the best effects; but a long continuance of them is invariably injurious.
There is a narcotic principle residing in most bitters, which physicians
have too much overlooked. It destroys the sensibility of the stomach,
determines to the head, and predisposes to apoplexy and palsy. This was
the effects of the famous Portland Powder,[30] so celebrated many years
ago for the cure of gout; and similar consequences will, in the long-run,
follow bitters as they are commonly administered. Persons addicted to
intemperance, have an inordinate liking for these substances; let them be
ever so nauseous, they are swallowed greedily, especially if dissolved in
spirits. Their fondness for purl, herb-ale, and other pernicious morning
drinks, is equally striking.
There is nothing more characteristic of a tippler than an indifference to
tea, and beverages of a like nature. When a woman exhibits this quality,
we may reasonably suspect her of indulging in liquor. If drunkards
partake of tea, they usually saturate it largely with ardent spirits. The
unadulterated fluid is too weak a stimulus for their unnatural appetites.
III. _State of the Brain._—Inflammation of this organ is often a
consequence of intemperance. It may follow immediately after a debauch,
or it may arise secondarily from an excess of irritation being applied
to the body, during the stage of debility. Even an abstraction of
stimulus, as by applying too much cold to the head, may bring it on in
this latter state.
Dr. Armstrong, in his lectures, speaks of a chronic inflammation of
the brain and its membranes, proceeding, among other causes, from the
free use of strong wines and liquors. According to him, it is much more
common after, than before, forty years of age, although he has seen
several instances occurring in young persons. The brain gets diseased,
the diameter of the vessels being diminished, while their coats are
thickened and less transparent than usual. In some places they swell out
and assume a varicose appearance. The organ itself has no longer the same
delicate and elastic texture, becoming either unnaturally hard, or of a
morbid softness. Slight effusions in the various cavities are apt to take
place. Under these circumstances, there is a strong risk of apoplexy.
To this structure is to be ascribed the mental debasement, the loss of
memory, and gradual extinction of the intellectual powers. I believe that
the brains of all confirmed drunkards exhibit more or less of the above
appearances.
IV. _State of the Kidneys._—During intoxication the action of the kidneys
is always much increased; and this is a favourable circumstance, as,
more than any thing else it carries off the bad effects of drinking. The
kidney, however, in confirmed drunkards, is apt to become permanently
diseased, and secretes its accustomed fluid with unusual activity, not
only in the moments of drunkenness, when such an increase is useful,
but at all periods, even when the person abstains from every sort of
indulgence. The disease called diabetes is thus produced, which consists
in a morbid increase of the secretion, accompanied with a diseased state
of the texture of the kidneys. This affection is mostly fatal.
V. _State of the Bladder._—Drunkenness affects this organ in common with
almost every other; hence it is subject to paralysis, spasm, induration,
&c., and to all bad consequences thence resulting—such as pain,
incontinence, and retention of urine.
VI. _State of the Blood and Breath._—The blood of a professed drunkard,
as already stated, differs from that of a sober man. It is more dark, and
approaches to the character of venous. The ruddy tint of those carbuncles
which are apt to form upon the face, is no proof to the contrary, as the
blood which supplies them is crimsoned by exposure to the air, on the
same principle as that by which the blood in the pulmonary arteries
receives purification by the process of breathing. The blood of a
malt-liquor drinker is not merely darker, but also more thick and sizy
than in other cases, owing, no doubt, to the very nutritious nature of
his habitual beverage.
The breath of a drunkard is disgustingly bad, and has always a spirituous
odour. This is partly owing to the state of the stomach, which
communicates the flavour of its customary contents to respiration; and
partly, also, there can be little doubt, to the absorption of the liquor
by the blood, through the medium of the lacteals.
VII. _State of the Perspiration._—The perspiration of a confirmed
drunkard is as offensive as his breath, and has often a strong spirituous
odour. I have met with two instances, the one in a Claret, the other in a
Port drinker, in which the moisture which exuded from their bodies had a
ruddy complexion, similar to that of the wine on which they had committed
their debauch.
VIII. _State of the Eyes, &c._—The eyes may be affected with acute or
chronic inflammation. Almost all drunkards have the latter more or less.
Their eyes are red and watery, and have an expression so peculiar, that
the cause can never be mistaken. This, and a certain want of firmness
about the lips, which are loose, gross, and sensual, betray at once the
toper. Drunkenness impairs vision. The delicacy of the retina is probably
affected; and it is evident, that, from long-continued inflammation, the
tunica adnata which covers the cornea must lose its original clearness
and transparency.
Most drunkards have a constant tenderness and redness of the nostrils.
This, I conceive, arises from the state of the stomach and œsophagus.
The same membrane which lines them is prolonged upwards to the nose and
mouth, and carries thus far its irritability.
There is no organ which so rapidly betrays the Bacchanalian propensities
of its owner as the nose. It not only becomes red and fiery, like that of
Bardolph,[31] but acquires a general increase of size—displaying upon
its surface various small pimples, either wholly of a deep crimson hue,
or tipped with yellow, in consequence of an accumulation of viscid matter
within them. The rest of the face often presents the same carbuncled
appearances.
I have remarked that drunkards who have a foul, livid, and pimpled face,
are less subject to liver complaint than those who are free from such
eruptions. In this case the determination of blood to the surface of the
body seems to prevent that fluid from being directed so forcibly to the
viscera as it otherwise would be. The same fact is sometimes observed in
sober persons who are troubled with hepatic affection. While there is
a copious rush upon the face or body, they are comparatively well, but
no sooner does it go in than they are annoyed by the liver getting into
disorder.
IX. _State of the Skin._—The skin of a drunkard, especially if he be
advanced in life, has seldom the appearance of health. It is apt to
become either livid or jaundiced in its complexion, and feels rough
and scaly. There is a disease spoken of by Dr. Darwin, under the title
of _Psora Ebriorum_, which is peculiar to people of this description.
“Elderly people,” says he, “who have been much addicted to spirituous
drinks, as beer, wine, or alcohol, are liable to an eruption all over
their bodies; which is attended with very afflicting itching, and which
they probably propagate from one part of their bodies to another with
their own nails by scratching themselves.” I have met with several cases
of this disease, which is only one of the many forms of morbid action,
which the skin is apt to assume in drunkards.
X. _State of the Hair._—The hair of drunkards is generally dry, slow of
growth, and liable to come out; they are consequently more subject to
baldness than other people. At the same time, it would be exceedingly
unjust to suspect any one, whose hair was of this description, of
indulgence in liquors, for we frequently find in the soberest persons
that the hairs are arid, few in number, and prone to decay. Baldness
with such persons is merely a local affection, but in drunkards it is
constitutional, and proceeds from that general defect of vital energy
which pervades their whole system.
XI. _Inflammations._—Drunkards are exceedingly subject to all kinds of
inflammation, both from the direct excitement of the liquor, and from
their often remaining out in a state of intoxication, exposed to cold and
damp. Hence inflammatory affections of the lungs, intestines, bladder,
kidneys, brain, &c., arising from these sources. Rheumatism is often
traced to the neglect and exposure of a fit of drunkenness.
XII. _Gout._—Gout is the offspring of gluttony, drunkenness, or
sensuality, or of them all put together. It occurs most frequently with
the wine-bibber. A very slight cause may bring it on when hereditary
predisposition exists; but in other circumstances considerable excess
will be required before it makes its appearance. It is one of the most
afflicting consequences of intemperance, and seems to have been known
as such from an early age—mention being made of it by Hippocrates,
Aretæus, and Galen. Among the Roman ladies gout was very prevalent during
the latter times of the empire; and, at the present day, there are few
noblemen who have it not to hand down to their offspring as a portion of
their heritage.
XIII. _Tremors._—A general tremor is an attendant upon almost all
drunkards. This proceeds from nervous irritability. Even those who are
habitually temperate, have a quivering in their hands next morning, if
they indulge overnight in a debauch. While it lasts, a person cannot hold
any thing without shaking, neither can he write steadily. Among those who
have long devoted themselves to the mysteries of Silenus, this amounts
to a species of palsy, affecting the whole body, and even the lips, with
a sort of paralytic trembling. On awaking from sleep, they frequently
feel it so strongly, as to seem in the cold fit of an ague, being neither
able to walk steadily, nor articulate distinctly. It is singular that the
very cause of this distemper should be employed for its cure. When the
confirmed drunkard awakes with tremor, he immediately swallows a dram:
the most violent shaking is quieted by this means. The opium-eater has
recourse to the same method: to remove the agitation produced by one dose
of opium, he takes another. This, in both cases, is only adding fuel to
the fire—the tremors coming on at shorter intervals, and larger doses
being required for their removal.
Drunkards are more subject than any other class of people to apoplexy and
palsy.
XIV. _Palpitation of the Heart._—This is a very distressing consequence
of drunkenness, producing difficult breathing, and such a determination
to the head as often brings on giddiness. Drunkards are apt to feel it as
they step out of bed, and the vertigo is frequently so great as to make
them stumble. There are some sober persons who are much annoyed by this
affection. In them it may arise from spasmodic action of the fibres of
the heart, nervous irritability, or organic disease, such as aneurism, or
angina pectoris.
XV. _Hysteria._—Female drunkards are very subject to hysterical
affections. There is a delicacy of fibre in women, and a susceptibility
of mind, which make them feel more acutely than the other sex all
external influences. Hence the whole system is often violently affected
with hysterics and other varieties of nervous weakness. These affections
are not always traced to their true cause, which is often neither more
nor less than dram-drinking. When a woman’s nose becomes crimsoned at
the point, her eyes somewhat red, and more watery than before, and her
lips fuller and less firm and intellectual in their expression, we may
suspect that something wrong is going on.
XVI. _Epilepsy._—Drunkenness may bring on epilepsy, or falling sickness,
and may excite it into action in those who have the disease from other
causes. Many persons cannot get slightly intoxicated without having an
epileptic or other convulsive attack. These fits generally arise in the
early stages, before drunkenness has got to a height. If they do not
occur early, the individual will probably escape them altogether for the
time.
XVII. _Sterility._—This is a state to which confirmed drunkards are very
subject. The children of such persons are, in general, neither numerous
nor healthy. From the general defect of vital power in the parental
system, they are apt to be puny and emaciated, and more than ordinarily
liable to inherit all the diseases of those from whom they are sprung.
On this account, the chances of long life are much diminished among the
children of such parents. In proof of this, it is only necessary to
remark, that according to the London bills of mortality, one-half of the
children born in the metropolis die before attaining their third year;
while, of the children of the Society of Friends, a class remarkable for
sobriety and regularity of all kinds, one-half actually attain the age
of forty-seven years. Much of this difference, doubtless, originates
in the superior degree of comfort, and correct general habits of the
Quakers, which incline them to bestow every care in the rearing of their
offspring, and put it in their power to obtain the means of combating
disease; but the main-spring of this superior comfort and regularity is
doubtless temperance—a virtue which this class of people possess in an
eminent degree.
XVIII. _Emaciation._—Emaciation is peculiarly characteristic of the
spirit drinker. He wears away, before his time, into the “lean and
slippered pantaloon” spoken of by Shakspeare in his “Stages of Human
Life.” All drunkards, however, if they live long enough, become
emaciated. The eyes get hollow, the cheeks fall in, and wrinkles soon
furrow the countenance with the marks of age. The fat is absorbed from
every part, and the rounded plumpness which formerly characterized the
body soon wears away. The whole form gets lank and debilitated. There is
a want of due warmth, and the hand is usually covered with a chill clammy
perspiration.
The occurrence of emaciation is not to be wondered at in persons who are
much addicted to ardent spirits, for alcohol, besides being possessed of
no nutritive properties, prevents the due chymification of the food, and
consequently deteriorates the quality, besides diminishing the quantity
of chyle. The principle of nutrition being thus affected, the person
becomes emaciated as a natural consequence.
XIX. _Corpulency._—Malt liquor and wine drinkers are, for the most part,
corpulent, a state of body which rarely attends the spirit drinker,
unless he be, at the same time, a _bon vivant_. Both wines and malt
liquors are more nourishing than spirits. Under their use, the blood
becomes, as it were, enriched, and a universal deposition of fat takes
place throughout the system. The omentum and muscles of the belly are,
in a particular manner, loaded with this secretion; whence the abdominal
protuberance so remarkable in persons who indulge themselves in wines
and ales. As the abdomen is the part which becomes most enlarged, so
is it that which longest retains its enlargement. It seldom parts with
it, indeed, even in the last stages, when the rest of the body is in a
state of emaciation. There can be no doubt that the parts which first
lose their corpulency are the lower extremities. Nothing is more common
than to see a pair of spindle shanks tottering under the weight of an
enormous corporation, to which they seem attached more like artificial
appendages, than natural members. The next parts which give way, are the
shoulders. They fall flat, and lose their former firmness and rotundity
of organization. After this, the whole body becomes loose, flabby, and
inelastic; and five years do as much to the constitution as fifteen would
have done under a system of strict temperance and sobriety. The worst
symptom that can befall a corpulent man, is the decline of his lower
extremities.[32] So long as they continue firm, and correspond with the
rest of the body, it is a proof that there is still vigour remaining;
but when they gradually get attenuated, while other parts retain their
original fulness, there can be no sign more sure that his constitution is
breaking down, and that he will never again enjoy his wonted strength.
XX. _Premature Old Age._—Drunkenness has a dreadful effect in
anticipating the effects of age. It causes time to pace on with giant
strides—chases youth from the constitution of its victims—and clothes
them prematurely with the grey garniture of years. How often do we see
the sunken eye, the shrivelled cheek, the feeble, tottering step, and
hoary head, in men who have scarcely entered into the autumn of their
existence. To witness this distressing picture, we have only to walk
out early in the mornings, and see those gaunt, melancholy shadows of
mortality, betaking themselves to the gin-shops, as to the altar of
some dreadful demon, and quaffing the poisoned cup to his honour, as
the Carthagenians propitiated the deity of their worship, by flinging
their children into the fire which burned within his brazen image. Most
of these unhappy persons are young, or middle-aged men; and though some
drunkards attain a green old age, they are few in number compared with
those who sink untimely into the grave ere the days of their youth have
well passed by.[33] Nothing is more common than to see a man of fifty
as hoary, emaciated, and wrinkled, as if he stood on the borders of
fourscore.
The effect of intemperance in shortening life is strikingly exemplified
in the contrast afforded by other classes of society to the Quakers, a
set of people of whom I must again speak favourably. It appears from
accurate calculation, that in London only one person in forty attains the
age of fourscore, while among the Quakers, whose sobriety is proverbial,
and who have long set themselves against the use of ardent spirits, not
less than one in ten reaches that age—a most striking difference, and one
which carries its own inference along with it.
It is remarked by an eminent practitioner, that of more than a hundred
men in a glass-manufactory, three drank nothing but water, and these
three appeared to be of their proper age, while the rest who indulged in
strong drinks seemed ten or twelve years older than they proved to be.
This is conclusive.[34]
XXI. _Ulcers._—Ulcers often break out on the bodies of drunkards.
Sometimes they are fiery and irritable, but in general they possess
an indolent character. Of whatever kind they may be, they are always
aggravated in such constitutions. A slight cause gives rise to them;
and a cut or bruise which, in health, would have healed in a few days,
frequently degenerates into a foul sloughy sore. When drunkards are
affected with scrofula, scurvy, or any cutaneous disease whatever, they
always, _cæteris paribus_, suffer more than other people.
XXII. _Melancholy._—Though drunkards over their cups are the happiest
of mankind, yet, in their solitary hours, they are the most wretched.
Gnawing care, heightened perhaps by remorse, preys upon their
conscience. While sober, they are distressed both in body and mind, and
fly to the bowl to drown their misery in oblivion. Those, especially,
whom hard fate drove to this desperate remedy, feel the pangs of low
spirits with sevenfold force. The weapon they employ to drive away care
is turned upon themselves. Every time it is used, it becomes less capable
of scaring the fiend of melancholy, and more effectual in wounding him
that uses it.
All drunkards are apt to become peevish and discontented with the world.
They turn enemies to the established order of things, and, instead of
looking to themselves, absurdly blame the government as the origin of
their misfortunes.
XXIII. _Madness._—This terrible infliction often proceeds from
drunkenness. When there is hereditary predisposition, indulgence in
liquor is more apt to call it into action than when there is none.
The mind and body act reciprocally upon one another; and when the one
is injured the other must suffer more or less. In intemperance, the
structure of the brain is no longer the same as in health; and the mind,
that immortal part of man, whose manifestations depend upon this organ,
suffers a corresponding injury.
Intoxication may affect the mind in two ways. A person, after excessive
indulgence in liquor, may be seized with delirium, and run into a
state of violent outrage and madness. In this case the disease comes
suddenly on: the man is fierce and intractable, and requires a strait
jacket to keep him in order. Some never get drunk without being insanely
outrageous; they attack, without distinction, all who come in their way,
foam at the mouth, and lose all sense of danger. This fit either goes
off in a few hours, or degenerates into a confirmed attack of lunacy.
More generally, however, the madness of intoxication is of another
character, partaking of the nature of idiotism, into which state the mind
resolves itself, in consequence of a long-continued falling off in the
intellectual powers.
Drunkenness, according to the reports of Bethlehem Hospital, and other
similar institutions for the insane, is one of the most common causes of
lunacy. In support of this fact, it may be mentioned that of two hundred
and eighty-six lunatics now in the Richmond Asylum, Dublin, one-half owe
their madness to drinking; and there are few but must have witnessed
the wreck of the most powerful minds, by this destructive habit. It has
a more deplorable effect upon posterity than any other practice, for it
entails, not only bodily disease upon the innocent offspring, but also
the more afflicting diseases of the mind. Madness of late years has been
greatly on the increase among the lower classes, and can only be referred
to the alarming progress of drunkenness, which prevails now to a much
greater extent among the poor than ever it did at any former period.[35]
XXIV. _Delirium Tremens._—Both the symptoms and treatment of this
affection require to be mentioned, because, unlike the diseases already
enumerated, it invariably originates in the abuse of stimuli, and is
cured in a manner peculiar to itself.
Those who indulge in spirits, especially raw, are most subject to
delirium tremens, although wine, malt liquor, opium, and even ether, may
give rise to it, if used in moderate quantities. The sudden cessation of
drinking in a confirmed toper, or a course of violent or long protracted
intemperance may equally occasion the disease. A man, for instance of the
former description, breaks his leg, or is seized with some complaint,
which compels him to abandon his potations. This man in consequence of
such abstinence is attacked with delirium tremens. In another man, it
is induced by a long course of tippling, or by a hard drinking-bout of
several days’ continuance.
The disease generally comes on with lassitude, loss of appetite, and
frequent exacerbations of cold. The pulse is weak and quick, and the
body covered with a chilly moisture. The countenance is pale, there are
usually tremors of the limbs, anxiety, and a total disrelish for the
common amusements of life. Then succeed retching, vomiting, and much
oppression at the pit of the stomach, with sometimes slimy stools. When
the person sleeps, which is but seldom, he frequently starts in the
utmost terror, having his imagination haunted by frightful dreams. To
the first coldness, glows of heat succeed, and the slightest renewed
agitation of body or mind, sends out a profuse perspiration. The tongue
is dry and furred. Every object appears unnatural and hideous. There is
a constant dread of being haunted by spectres. Black or luminous bodies
seem to float before the person: he conceives that vermin and all sorts
of impure things are crawling upon him, and is constantly endeavouring
to pick them off. His ideas are wholly confined to himself and his own
affairs, of which he entertains the most disordered notions. He imagines
that he is away from home, forgets those who are around him, frequently
abuses his attendants, and is irritated beyond measure by the slightest
contradiction. Calculations, buildings, and other fantastic schemes
often occupy his mind; and a belief that every person is confederated to
ruin him, is commonly entertained. Towards morning there is often much
sickness and sometimes vomiting. This state generally lasts from four to
ten days, and goes off after a refreshing sleep; but sometimes either
from the original violence of the disease, or from improper treatment, it
proves fatal.
Such, in nine cases out of ten, is the character of delirium tremens.
Sometimes, however, the symptoms vary, and instead of a weak there is a
full pulse; instead of the face being pallid, it is flushed and the eyes
fiery; instead of a cold clammy skin, the surface is hot and dry. This
state only occurs in vigorous plethoric subjects. An habitually sober
man who has thoughtlessly rushed into a debauch, is more likely to be
attacked in this mariner than a professed drunkard. Indeed, I never met
with an instance of the latter having this modification of the disease.
When the patient perishes from delirium tremens he is generally carried
off in convulsions. There is another termination which the disease
sometimes assumes: it may run into madness or confirmed idiotism. Indeed,
when it continues much beyond the time mentioned, there is danger of the
mind becoming permanently alienated.
Subsultus, low delirium, very cold skin, short disturbed sleep,
contracted pupil, strabismus, rapid intermittent pulse, and frequent
vomiting, are indications of great danger. When the patient is affected
with subsultus from which he recovers in terror, the danger is extreme.
In treating delirium tremens, particular attention must be paid to the
nature of the disease, and constitution of the patient. In the first
mentioned, and by far the most frequent variety, blooding, which some
physicians foolishly recommend, is most pernicious. I have known more
than one instance where life was destroyed by this practice. As there is
generally much gastric irritation, as is indicated by the foul tongue,
black and viscid evacuations, and irritable state of the stomach, I
commence the treatment by administering a smart dose of calomel. As soon
as this has operated, I direct tepid water strongly impregnated with
salt, to be dashed over the body, and the patient immediately thereafter
to be well dried and put to bed. I then administer laudanum in doses of
from forty to sixty drops, according to circumstances, combining with
each dose from six to twelve grains of the carbonate of ammonia: this
I repeat every now and then till sleep is procured. It may sometimes
be necessary to give such doses every two hours, or even every hour,
for twelve or twenty successive hours, before the effect is produced.
The black drop in doses proportioned to its strength, which is more
than three times that of laudanum, may be used as a substitute for the
latter; the acetate or muriate of morphia, in doses of a quarter or half
a grain, is also a good medicine, having less tendency to produce stupor
or headach than laudanum, and therefore preferable in cases where the
patient is of a plethoric habit of body. It must be admitted, however,
that their effects are less to be depended upon than those of laudanum,
which, in all common cases will, I believe, be found the best remedy.
The great object of the treatment is to soothe the apprehensions of the
patient, and procure him rest. So soon as a sound sleep takes place
there is generally a crisis, and the disease begins to give way; but
till this occurs it is impossible to arrest its progress and effect a
cure. A moderate quantity of wine will be necessary, especially if he
has been a confirmed drinker, and labours under much weakness. Perhaps
the best way of administering wine is along with the laudanum, the
latter being dropped into the wine. Where wine cannot be had, porter
may be advantageously given in combination with laudanum. The principal
means, indeed, after the first purging, are opium, wine, ammonia, and
tepid effusion: the latter may be tried two, three, or four times in the
twenty-four hours, as occasion requires. The mind is, at the same time,
to be soothed in the gentlest manner, the whimsical ideas of the patient
to be humoured, and his fancies indulged as far as possible. All kinds
of restraint or contradiction are most hurtful. Some recommend blisters
to the head, but these are, in every case, injurious. So soon as all
the symptoms of the disease have disappeared some purgative should be
administered, but during its progress we must rely almost wholly upon
stimulants. To cure, by means of stimuli, a complaint which arose
from an over-indulgence in such agents, is apparently paradoxical; but
experience confirms the propriety of the practice where, _a priori_, we
might expect the contrary.
In the second variety of the disease, the same objections do not apply
to blood-letting as in the first, but even there, great caution is
necessary, especially if the disease has gone on for any length of time,
if the pulse is quick and feeble or the tongue foul. At first, general
blooding will often have an excellent effect, but should we not be
called till after this stage it will prove a hazardous experiment. Local
blooding will then sometimes be serviceable where general blooding could
not be safely attempted. The patient should be purged well with calomel,
have his head shaved, and kept cool with wet cloths, and sinapisms
applied to his feet. When the bowels are well evacuated, and no symptoms
of coma exist, opiates must be given as in the first variety, but in
smaller and less frequently repeated doses.
Much yet remains to be known with regard to the pathology of delirium
tremens. I believe that physicians have committed a dangerous error, in
considering these two varieties as modifications of the same disease.
In my opinion they are distinct affections and ought to be known under
different names. This cannot be better shown than in the conflicting
opinions with regard to the real nature of the disease. Dr. Clutterbuck,
having apparently the second variety in his eye, conceives that delirium
tremens arises from congestion or inflammation of the brain; while
Dr. Ryan, referring to the first, considers it a nervous affection,
originating in that species of excitement often accompanying debility.
It is very evident, that such different conditions require different
curative means. The genuine delirium tremens is that described under the
first variety, and I agree with Dr. Ryan in the view he takes of the
character of this singular disease.
GENERAL REMARKS.—Such are the principal diseases brought on by
drunkenness. There are still several others which have not been
enumerated—nor is there any affection incident to either the body or
mind which the vice does not aggravate into double activity. The number
of persons who die in consequence of complaints so produced, is much
greater than unprofessional people imagine. This fact is well known to
medical men, who are aware that many of the cases they are called upon
to attend, originate in liquor, although very often the circumstance
is totally unknown either to the patient or his friends. This is
particularly the case with regard to affections of the liver, stomach,
and other viscera concerned in digestion. Dr. Willan, in his reports of
the diseases of London, states his conviction that considerably more than
one-eighth of all the deaths which take place in persons above twenty
years old, happen prematurely through excess in drinking spirits. Nor
are the moral consequences less striking: Mr. Poynter, for three years
Under-Sheriff of London and Westminster, made the following declaration
before a Committee of the House of Commons:—“I have long been in the
habit of hearing criminals refer all their misery to drinking, so that I
now almost cease to ask them the cause of their ruin. This evil lies at
the root of all other evils of this city and elsewhere. Nearly all the
convicts for murder with whom I have conversed, have admitted themselves
to have been under the influence of liquor at the time of the act.” “By
due observation for nearly twenty years,” says the great Judge Hales,
“I have found that if the murders and manslaughters, the burglaries and
robberies, and riots and tumults, the adulteries, fornications, rapes,
and other great enormities, that have happened in that time, were
divided into five parts, four of them have been the issues and product of
excessive drinking—of tavern and ale-house meetings.” According to the
_Caledonian Mercury_ of October 26, 1829, no fewer than ninety males,
and one hundred and thirty _females_, in a state of intoxication, were
brought to the different police watchhouses of Edinburgh, in the course
of the previous week—being the greatest number for many years. Nor is
Glasgow, in this respect, a whit better than Edinburgh. On March 1, 1830,
of forty-five cases brought before the police magistrate in Glasgow,
forty were for drunkenness; and it is correctly ascertained that more
than nine thousand cases of drunkenness are annually brought before the
police, from this city and suburbs—a frightful picture of vice. In the
ingenious Introductory Essay attached to the Rev. Dr. Beecher’s Sermons
on Intemperance, the following passage occurs, and I think, instead of
exaggerating it rather underrates the number of drunkards in the quarter
alluded to. “Supposing that one-half of the eighteen hundred licensed
houses for the sale of spirits which are in that city, send forth each
a drunken man, every day, there are, in Glasgow, nine hundred drunken
men, day after day, spreading around them beggary, and wretchedness, and
crime!” Had the author given to each licensed house, one drunkard on an
average, I do not think he would have overstepped the bounds of truth.
As it is, what a picture of demoralization and wretchedness does it not
exhibit!