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!