Alcoholism is the term employed to denote the symptoms of disease produced by alcoholic poisoning. It is usual to consider the subject under two heads, according as the affection is acute or chronic. Acute alcoholism, which is generally caused by the rapid absorption of a large quantity of alcohol, commonly begins with the same train of symptoms—animation of manner, exaltation of spirits, and relaxation of judgment, which lead to want of mental control. The emotions are also affected, always being altered, and often perverted. The co-ordination of muscular movements is impaired, and they become irregular or ataxic in character. The mechanism of speech is, as a rule, the first to suffer, but other muscular efforts are also rendered imperfect, the erect posture even becoming impossible. Thus far, the initial manifestations are tolerably uniform, but the further development of the symptoms presents three different series of effects. In the ordinary course of the action of the drug, the individual suffers from headache, giddiness, disturbance of sight and hearing, and other troubles due to disorder of the central nervous system, which lead to heavy sleep or profound coma. Usually the individual may be roused from the sleep or coma, but when this is very deep it may be impossible to do so, and he lies completely paralysed, breathing stertorously. Sometimes the alcohol produces such a powerful effect upon the centres of respiration and circulation that death is caused by paralysis of one or other, or both. This condition of coma requires to be carefully distinguished from opium poisoning. In the former, the face is usually flushed and the pupils dilated, while in the latter the face is pale and the pupils contracted; but these appearances are not constant; and it need hardly be added that the odour of the breath is no criterion, inasmuch as the use of spirits is regarded as the panacea in all conditions of depression, and sympathising bystanders are prompt to administer them in every case, often with very hurtful effects. The second class of effects is entirely different from the foregoing. Instead of sinking into sopor or coma, the individual under the influence of the poison becomes more and more excited, bursts into wild mirth or passionate anger, engages in violent struggles with any one who attempts to soothe him, and may do grievous bodily harm to himself or others. This is the condition known as alcoholic mania, and it is the physical explanation of many fearful crimes. After a longer or shorter period of fierce excitement, it is in most cases succeeded by great depression, and sometimes during this condition there may be sudden death from failure of the respiration or circulation. In the third division, the stage of excitement culminates in a convulsive seizure somewhat resembling that seen in hysterio-epilepsy. The convulsions, which are repeated at intervals, are very complicated in their character, and produce remarkable contortions of the body. These usually become less violent as they recur, and passing off, end in deep sleep; but here also death may occur from the action of the poison. It should be observed that acute alcoholism is more apt to occur in those who are of unsound mind and weak nervous system, and this applies especially to the two last-described forms of the affection. In the treatment of acute alcoholism, it is sometimes necessary to wash out the stomach in case any alcohol may be present, but from its rapid absorption this is rarely the case. In the profound coma the administration of stimulants, such as ammonia, may be called for, and sometimes artificial respiration may be the only means of saving life. In the maniacal and convulsive forms of the affection, chloral along with bromide of potassium must be used. After the immediate symptoms have passed away in all forms, the individual must be carefully fed, on account of the disturbance of the digestive system which is caused by the overdose of alcohol, with nutrient enemata, along with remedies which will subdue the digestive irritation and stimulate the depression of the nervous system.
Chronic alcoholism is caused by the prolonged use of overdoses of various alcoholic drinks. The drug causes changes in every tissue of the body, but it more especially affects the nervous, respiratory, and circulatory systems, together with the liver and kidneys. There is always more or less catarrh of the digestive organs, shown by dyspepsia, heartburn, flatulence, nausea, vomiting—especially in the morning—and usually diarrhoea. The liver, to which, in the first instance, all the alcohol absorbed is carried by the vessels, becomes enlarged from congestion in the early stages; and it afterwards shrinks, from the development of fibrous tissue by chronic irritation and the subsequent contraction of this new growth; it exercises pressure on the veins bringing back blood to the heart from the abdominal viscera—thus leading to congestion of the bowels, haemorrhoids, and haemorrhages. In some cases there is fatty degeneration of the liver, with or without the fibrous change. From changes in the organs of circulation, there is a tendency to palpitation, fainting, and breathlessness on exertion. These alterations are degenerations of the heart, which may be soft and flabby, or even fatty; fibrous changes in the walls of the arteries; and dilatation of the capillaries from paralysis of the vaso-motor nerves. This last condition gives the florid complexion and mottled appearance to chronic drinkers, and it renders them prone to all inflammations, which, as may be expected, are much more fatal to them than to temperate men. Connected with these changes in the circulation, there is usually some congestion of the kidneys; but it is erroneous to attribute Bright's Disease mainly to alcohol. The lungs are subject to chronic congestion and catarrh of the bronchial tubes and lung-tissues. The muscular system suffers, the muscles becoming flabby and fatty. There is a great tendency to deposition of fat, from interference with digestion, and skin-diseases are frequently induced by the vaso-motor changes.
But of all the symptoms of chronic alcoholism those connected with the nervous system are the most characteristic. The moral sense is impaired, the will-power weakened, and the intellectual energies enfeebled, but there are in addition two characteristic results of the poisonous action of the drug upon the central nervous structures. These are delirium tremens and alcoholic insanity. The former consists in a delirium, varying from quiet wandering to wild mania, marked by hallucinations, usually of a revolting character, such as of creeping reptiles, with tremulousness of the muscles, attended by sleeplessness: the latter may assume many of the clinical aspects of insanity. After death, the morbid anatomy consists in congestion of the membranes of the brain, which are more adherent to the skull and brain than in health; there is usually opacity of the middle or arachnoid membrane, and an increase in the cerebro-spinal fluid. The brain and spinal cord show no definite alterations. The peripheral nervous system also suffers, and there may be pain and tenderness, or loss of sensibility, and tremor, spasm, or paralysis in various areas, according as the sensory or motor nerves are affected. The appearances after death are those of neuritis, or inflammation of the nerves supplying the affected regions. In the treatment of chronic alcoholism, the great point is to put a stop to the employment of alcohol in every form, and this usually requires careful moral discipline. The bodily and mental functions must be invigorated by all means, and an outdoor life is one of the best methods of carrying this out. The different symptoms connected with the various systems must be met as they present themselves. In delirium tremens the patient must have sleep, which is best obtained by the use of bromide of potassium and chloral hydrate. Alcoholic insanity falls to be considered under INSANITY. See also the articles on DELIRIUM TREMENS, DIPSOMANIA, INEBRIATES (Retreats for), TEMPERANCE.