Pathological changes induced by chronic alcoholism are very numerous. Chronic congestion and irritation of the stomach lead to catarrhal gastritis. In the liver new connective tissue forms, particularly in the acini most in contact with the alcohol undergoing combustion. Chronic cirrhosis results with its train of symptoms: ascites, jaundice, biliary infections, etc. Fatty degeneration is common. The circulatory changes are prominent. In beer-drinkers, particularly in those who drink large quantities, there is cardiac dilatation and hypertrophy with degeneration. These patients, usually workers connected with brewing industries, develop the so-called "beer heart." The alcohol, plus the large amounts of water, dilates the stomach; there is irregular and slow, or galloping pulse, with dyspnea and cyanosis.

The continued heart strain leads to myocardial degeneration and to fatty changes. Vessel changes of an arteriosclerotic nature are also present. In the kidneys the vascular changes are the most important factors. These lead to kidney inefficiency, and the irritation or suboxidation to new connective tissue formations, with the development of chronic forms of nephritis.

The nervous tissues are profoundly affected. Changes in the peripheral nerves, nerves of trophic influences, spinal cord, optic nerve, and brain are frequent. In the peripheral nerves a neuritis may develop, leading to isolated paralyses or anesthesiae, or to multiple neuritis and general peripheral sensory disturbances. Alcoholic paralysis usually affects the extensors, causing wrist-drop and foot-drop, and is, as a rule, accompanied with some sensory disturbances (see Lead Palsy, Arsenical Neuritis). Trophic disorders, herpes, urticaria, ulceration, etc., are not uncommon. In the spinal cord a partial degeneration of the sensory neurons of the posterior columns leads to a pseudo-tabes, the symptoms closely resembling those of locomotor ataxia. In the eye partial or complete blindness may occur, amblyopia and amaurosis being particularly prevalent following the use of methyl alcohol. Scotomata are common, particularly in reds and greens. In the brain an acute psychosis -delirium tremens - may be set up, or a slow grade of alcoholic dementia supervene.

Treatment of Acute Alcoholic Poisoning. - The stomach should be emptied of all unabsorbed alcohol; cautious inhalations of ammonia should be given, accompanied by the internal administration of black coffee. The patient should be put in warm blankets, made to perspire freely, and if there is great danger of collapse, artificial respiration should be practised and strychnine should be administered. Alcohol derivatives should be avoided.

Treatment of Delirium Tremens. - The management of this phase of alcoholism requires great skill and judgment. The main indications are:

(1) Elimination. - By diaphoresis, catharsis, diuresis, warm baths, etc.

(2) Support. - Some alcohol may be necessary. Easily digested food. Enemata if necessary.

(3) Quiet. - Hypnotics: opium, chloral, bromides. Treatment of Chronic Alcoholism. - The therapeusis of chronic alcoholism or inebriety turns, like that of any other morbid condition, on the definition of inebriety. In such conditions the relative element is largely involved, not merely as to quantity drunk, but also as to the character of the individual affected. A thoughtful and extended experience with dipsomaniacs will convince most observers that the great majority of them suffer from a disease possessing usually a distinct and traceable etiology, and resulting from either inherited or acquired neurosis. It is a condition akin to epilepsy; the treatment of dipsomania, therefore, turns on the discovery of the conditions preliminary to the drinking period and the determination whether this can be prevented by dietetic and therapeutic methods, as is done in cases of epilepsy.

The medicinal agents most serviceable in the treatment of chronic alcoholism are strychnine, atropine, small doses of the alteratives, arsenic, potassium iodide, and mercury, while phosphorus and other restoratives and tonics will frequently be found useful.

The hygienic surroundings should be of the best, and the treatment should include a nutritious, non-stimulating diet taken with regularity, and the free use of fruits and vegetables. Close attention should be paid to the condition of the bowels and skin, and among other remedial influences should be mentioned laxatives when necessary, balneotherapy, mental and moral treatment, and, above all, change of scene and engaging mental occupation.

Inebriety is so varied in form, so subtle in operation, so intricate in development, and so complex in causation that its treatment is no easy task. Its management, therefore, is management of a protracted disorder, where any "specific" becomes an absurdity, since the patient, and not the disease, requires treatment.

From time to time various drugs have been heralded as specifics in the treatment of alcoholism, certain "cures" (sic) acquiring an influence among the ignorant and unscientific wholly at variance with therapeutic value of these vaunted remedies. It is superfluous to say that for a skilled and enlightened professional judgment the rationale of intemperance and the agents serving to mitigate the malady present a problem far too complicated to be grasped by the empirical understanding, operating even under the most ingenuous motives.

Therapeutics. - Externally and Locally. - Alcohol is an efficient application for contusions, sprains, and indolent ulcers, and is also serviceable in hardening the skin and preventing the formation of bed-sores. It is a useful hemostatic to check capillary oozing, and, being a powerful antiseptic, is available in all wounds. Uterine hemorrhage is controlled by inserting in the cavity of the uterus a tampon saturated with the drug.

Its local anesthetic properties render alcohol valuable in relieving irritation of the skin in urticaria, frost-bite, etc.; it also serves as an efficient gargle in diphtheria and acute pharyngitis.