A similar lesson may be learned from the obesity of alcohol users. These accumulate fat because the addition of the alcohol supplies a readily oxidizable substance and the normal fat is not called on for purposes of combustion.

In some particulars alcohol retards certain combustions, interfering at times with the full oxidizing properties of the liver cells, but the precise limits of activity are inadequately known.

In reference to the action of alcohol on the protective agents of the blood-plasma the evidence is inconclusive. It seems fairly well established that continued alcohol-taking reduces the resistance of the body to infections, but it also seems probable that in infectious diseases, for the non-alcoholic, alcohol contributes in some manner to the antitoxic properties of the blood serum. The studies on this subject, however, are far from being conclusive.

Eye. - The excessive use of alcohol may produce amblyopia, watery eyes, and congested conjunctivae.

Untoward action is fully described under "Poisoning."

Poisoning. - The untoward or poisonous action of alcohol may be divided into what are known as Acute and Chronic Alcoholism.

Acute Intoxication. - The general physiological phenomena leading up to acute poisoning by alcohol have been discussed, but the clinical picture, while too familiar, may be of service in differential diagnosis. The patient thoroughly under the influence of the drug is lying prostrate, usually in a more or less loose and lax position. His clothing is apt to be much awry and soiled and frequently wet with urine from the diuresis and gradual increase of loss of ability to control the acts of toilet. On inspection the face is found either flushed and warm in the lighter or early forms of intoxication, or cold and cyanosed in the deep narcoses. The breathing is deep early; or shallow and stertorous later; always in this condition slower than normal (8-10 per minute), in contrast to 5-6 per minute for severe opium poisoning. The pulse may be full and normal in rate, or in the very severe grades small and thin and wiry. The body temperature by rectal thermometric reading is reduced invariably 1 to 2 or even 40 F. The eyes are suffused and bloodshot, the pupils moderately contracted or dilated, depending on the depth of the narcosis. In fatal cases wide dilatation is the rule. The mouth is apt to be moist unless long exposure and stertorous breathing have dried it. An odor of alcohol is present. Too much stress should not be laid on this odor. Mistakes are too often made in the diagnosis between fractured skull and alcoholism because the breath smells of alcohol. Great care must be taken when the two conditions are present. Further examination of the patient will show him difficult or impossible to arouse, and only by pressure on a prominent nerve trunk can a response be obtained. The knee-jerks are abolished, and may be the corneal reflex. Catheterization of the bladder usually reveals a comparatively full bladder, and the urine does not contain any copper-reducing substances - compare with chloral poisoning; diabetes; some skull fractures.

A type of subacute alcohol poisoning is known as Delirium tremens. It usually follows a bout of heavy continuous drinking. Its onset may be gradual; or following an injury, psychical or physical shock, or even an attack of infectious disease, the train of symptoms may develop very rapidly. Thus in some of this latter type acute delirium tremens may follow immediately after a fracture or during an attack of pneumonia. Sudden grief may also precipitate an attack.

In the gradual cases the early symptoms are those of gradually increasing restlessness; the patient must be up and doing. Wakefulness or insomnia develops and the patient loses his appetite. Muscular tremor of a very fine type, or occasionally muscular twitching or jerking, may be present. There is an increase in all of the patient's reflexes. Irritability is marked, and from the increasing meningeal or cerebral irritation visual and auditory hallucinations begin to develop. At first these are absent in the daytime, and only become bothersome as the patient retires, but later the hallucinations become more marked. They often are representative of the patient's regular occupations; but more classically the visual hallucinations are terrifying in their character - sometimes of the nightmare order - frequently of animals, etc. From this condition, the cerebral irritation progressing, acute maniacal delirium develops. This may end by a fatal collapse.

Chronic alcoholism is generally the result of the continuous and excessive use of alcohol. The symptoms vary according to the individual case. There may be (1) the moderate or immoderate daily drinker; (2) the periodical inebriate. The periodical inebriate, strictly speaking, is not an inebriate at all, as a rule. There is a widespread distinction between the true periodical inebriate or the dipsomaniac and the inebriate proper. An alcoholic patient becomes insane because he drinks; a dipsomaniac is insane before he commences to drink. Dipsomania may be complicated by alcoholic symptoms, but alcoholism never leads to true dipsomania. Alcoholism is an intoxication having as its cause alcohol, while dipsomania has as its origin a congenital defective condition and alcohol is a secondary factor, which may be replaced by any other intoxicant leaving the syndrome all its psychologic characters. The alcoholic element is a mere manifestation determined at the outset of the attacks.

The habitual drinker sooner or later suffers from disturbed digestion, gastric catarrh, and irregularity of the bowels; his face is usually puffed and bloated, while the capillaries, especially of the cheeks and nose, become permanently dilated, marked acne rosacea not infrequently developing in the latter organ.

The description of types of alcoholic psychoses should be sought for in works on psychiatry. These psychoses are of immense practical importance.