In considering the action of alcohol upon the nervous system, one must distinguish between the effect it produces upon the various nerve-centres by increasing the circulation through them, and the effect of the alcohol on the nervous structures themselves. By increasing the circulation it may stimulate the functions of all the nerve-centres, and render them, for the time being, capable of greater activity. It may thus enable its consumer to think more clearly, to express himself more fluently, or to perform feats of greater bodily activity than usual, but its action on the nerve-centres themselves is a paralysing one.

The mode of action of alcohol on the circulation has not been well ascertained; but it seems probable that in considering it we must take into account both its direct action upon the circulatory apparatus itself and its reflex action upon that through other organs. Thus it is not improbable that even from the mouth it exercises an influence over the cranial circulation (p. 193). Although we have no experiments on the effect of irritation of the branches of the fifth nerve on the cranial circulation, yet individuals of all nations, when desiring to think more accurately, are accustomed to irritate some branch of this-nerve, either by scratching the head, rubbing the forehead or chin, striking the nose or taking snuff. Chewing sweet or pungent substances has a similar effect in enabling some persons to think more clearly, while, under similar circumstances, alcohol is sipped by others. From the stomach it probably stimulates the heart and vascular system reflexly, and thus increases both the cranial and the general circulation. When given in very large doses, as when a bottle of whiskey has been drunk at a draught, the reflex action on the heart has been so great that death has occurred immediately from shock.

Its action upon the nervous tissues themselves seems to be One of progressive paralysis, affecting them in the inverse order bf their development, the highest centres being affected first,.

and the lowest last. Thus the power of judgment usually goes first, while the imagination may be lively, and the emotions even more than usually active, so that, after a man becomes incapable of discussion, he is combative, affectionate, or lachrymose. The motor centres may be next affected, either after or before the perceptive centres, so that the speech may be uncertain and thick while the power of judgment is little affected, or the speech may remain tolerably distinct after the power of clear conception is entirely gone. The cerebellum appears to be affected sometimes before and sometimes after the cerebrum. This depends partly upon the constitution of the individual, and partly upon the quality of the alcoholic liquor. The affection of the cerebellum gives rise to double vision and inability to walk, from the relations of surrounding objects being no longer correctly perceived. After both cerebrum and cerebellum are paralysed, the cord may still retain its functional activity, so that the man who cannot walk may be able to ride, owing to the reflex contraction of the adductors produced by the impression of the saddle. The respiratory centre is next paralysed, if the quantity taken be sufficiently large. The heart continues to beat although the respiration may be paralysed; but if a sufficient dose of alcohol be administered, and respiration be kept up artificially in an animal, so as to allow the drug to act upon the heart, the cardiac ganglia may also become paralysed.

The sensibility of the vaso-motor centre to reflex impressions appears to be early destroyed, and the consequence of this is that injuries which in a sober man would produce death by shock, have comparatively little effect on a man who is drunk.

The diagnosis of drunkenness from opium-poisoning and from apoplexy is of great practical importance, for it occasionally happens that cases brought into hospital by the police have been dismissed as cases of drunkenness, and have proved afterwards to be cases of apoplexy. The difficulty of diagnosis is increased by the fact that the patient may have had alcoholic drinks poured down his throat by sympathetic bystanders, so that the first indication of drunkenness, viz. the smell of alcohol in the breath, may occur equally in apoplexy. The other chief points of diagnosis are given under 'Opium ' (p. 848).

Effect of Impurities on the Action of Alcohol. - It will It seen by the annexed table from Dujardin-Beaumetz that the toxic action of alcohol is greatly increased by impurities, so that inferior brandy from a public-house has a lethal action nearly one-half greater (as 5.30 to 7.75) than pure ethylic alcohol.

Chronic Alcoholic Poisoning. - In persons who are accustomed to take an excessive quantity of alcoholic stimulants for a length of time, although perhaps never sufficient to produce the symptoms of acute intoxication, alterations are produced in the digestive and nervous systems. One of the commonest evidences

Toxic Action Of Alcohol

Kind of Spirit

Mean toxic doses per kilogramme of body-weight of dog, to cause death in 24-36 hours

Spirits and Brandies

Crude

Rectified

grammes

grammes

grammes

Ethylic alcohol.......

7.75

...

...

Spirit of wine of Montpellier.....

7.50

...

...

,, ,, from pears.....

7.35

...

...

„ ,, from cider and from the marc of grapes

7.30

...

...

Spirit from grain.......

...

6.96

7.25

„ from molasses and beetroot...........................................

...

6.90

7.15

Brandy from a public-house (ordinary quality).......................

7.0

...

...

„ „ „ (inferior quality)......................

5.30

...

...

Spirit from potatoes ......

...

6.85

7.10

,, ,, ,, (said to have been ten times rectified).........................................................................

...

...

7.35

of this condition is vomiting of watery fluid in the morning immediately after rising. The bowels are rarely, if ever, constipated, being generally open three or four times daily. There is a tendency to fatty degeneration of various organs, the skin acquires a satiny feeling, and the capillaries on the surface of the face often become prominently dilated, giving a characteristic hue to the complexion, which is often especially marked upon the nose. The liver is apt to undergo fatty degeneration, and, at first, to be congested. Afterwards, the connective tissue becomes increased, the organ contracts, interfering with the circulation in the abdominal viscera, and producing ascites. This may be complicated by cirrhosis of the kidney also. The nervous system may also be affected, the mental powers becoming impaired, the temper, at the same time, frequently being irritable, while a tremulousness appears in the tongue, lips, and hands.