Late in the course of lobar pneumonia in persons accustomed to much alcohol there is sometimes seen a peculiar maniacal delirium verging on delirium tremens. In such cases the delirium may not yield until good-sized doses of whisky or brandy are administered.

The cure of alcoholism depends on the patient's desire for cure, on the temperament of the patient, and on the type of the drinker. White says that alcohol is not a habit-drug, but that the alcoholic wants to believe it a habit, so as to excuse his resorting to it to take him away from reality, i. e., the feeling of inefficiency. From a therapeutic point of view inebriates may be classed as: those who do not have an irresistible craving for alcohol, and those who do have the craving (Crothers). The former drink because others do, or from bravado, or for other reasons, and can often be readily induced to stop drinking. The latter are constant drinkers, periodic excessive drinkers, or dipsomaniacs. Their treatment is the same, except that in the case of the dipsomaniac restraint is a requisite at the time of the onset of the attack. Among the favorite schemes of treatment are hyoscine hydrobromide or hyoscyamine or atropine sulphate, 1/100 grain (0.0006 gm.) thrice daily, which causes great dryness of the throat and a loss of taste for the liquor; strychnine sulphate, 1/30 grain three times a day, to tone up the system; and hot bitter carminatives to supply oral and gastric stimulation. Doctoring whisky with apomorphine and then allowing the patient to drink whenever he wishes is another method in vogue. The nausea and vomiting destroy the taste for liquor.

Alexander Lambert administers 5 compound cathartic pills and 5 grains of blue mass every twelve hours until green stools appear, then 2 ounces of castor oil. During the process he gives to nervous or elderly persons 2 ounces of whisky four or five times in the first twenty-four hours, then only strychnine or digitalis, and a sleep mixture of chloral hydrate, morphine, tincture of hyoscyamus, ginger, and capsicum. If the patient has an intolerant stomach, he gives 5 grains of sodium bicarbonate and 5 grains of compound morphine powder every two or three hours for two or three doses. During the whole treatment he gives from 2 to 18 drops every hour of a mixture of two parts of 15 per cent. tincture of belladonna and one part each of the fluidextracts of hyoscyamus and xanthoxylum.

The Pathologic Effects On Organs

After drinking large quantities has been the habit for a long time, certain destructive changes are prone to appear in the organs. These are cirrhosis of the liver and fatty liver, chronic gastritis, chronic nephritis, myocarditis, fatty degeneration of the heart, arteriosclerosis, pulmonary emphysema, chronic leptomeningitis, peripheral neuritis, various spinal and cerebral scleroses, and atrophy of the testicles. In the brain-cells the chromatin network is replaced by fine granules or lost in the cytoplasm. The "wet brain," i.e., edema of the brain and meninges, is common in death from delirium tremens. Though alcohol is undoubtedly an important factor in the production of these lesions, it is believed nowadays that the influence of alcohol has been exaggerated, and that there are other important causative factors. At any rate such lesions are not infrequently seen in persons who have not been alcoholic. Simmonds, of Hamburg, found that in 100 cases of cirrhosis of the liver 14 were non-alcoholic. In 309 autopsies on chronic alcoholics at the Hafenkrankenhaus, Fahr, of Hamburg, found striking cirrhosis in only 13 cases, though fatty changes were usual. In 30 per cent. there was fatty infiltration of the heart, in 20 per cent. chronic gastritis, in 8 per cent. chronic nephritis, in 50 per cent. chronic leptomeningitis. Arteriosclerosis was rather less common than among other cases of corresponding age.

Richard Cabot has looked up some statistics of arteriosclerosis in Boston. Of 283 cases of chronic excessive alcoholism under fifty years of age, only 6 per cent. showed evidence of arteriosclerosis. Of 45 cases of arteriosclerosis, only 13 per cent. gave a history of alcoholism. Of 556 cases of arteriosclerosis found postmortem, only 95 (14.5 per cent.) were under fifty years of age, and of this 95, only 21 per cent. appear to have consumed alcohol in excess.

The following is Welch's summary of the pathologic changes in the rabbits used by Friedenwald (1905) in studying experimental alcoholism. The daily dose was 5 to 8 c.c. of absolute alcohol in 15 to 30 c.c. of water, or 10 to 20 c.c. of whisky diluted with 10 to 20 c.c. of water.

1. Animals exhibit marked individual differences in their susceptibility to the injurious effects of the prolonged administration of intoxicating doses of alcohol. Some rabbits given intoxicating doses every day for four years presented no serious anatomic lesion attributable to the alcohol, while to similar doses others succumbed quickly.

2. The most common pathologic condition is a fatty metamorphosis affecting especially the cells of liver, heart muscle, and kidney, the lesion speedily disappearing on the stoppage of alcohol. Necrosis of limited groups of cells in liver and kidneys may occur, but is inconstant. An acute or chronic gastritis may appear, but is often absent. Hyperemia and small hemorrhages may occur, especially in stomach, kidneys, and brain.

3. Alcoholic intoxication increases the susceptibility of animals to many infections, and influences unfavorably the process of immunization. Pregnant rabbits repeatedly intoxicated are prone to abort, or many of their young die in a few days after birth.

Reid Hunt (1907) experimented with smaller doses through four generations of guinea-pigs, and concluded that those given a few cubic centimeters of 5 to 10 per cent. alcohol with their daily food grew just as quickly, reached maturity as soon, and were just as fertile as those with no alcohol. They showed no symptoms, no loss of weight, no pathologic changes.