The long-continued action of alcohol on the nervous system produces other disorders besides delirium tremens. Hemi-anaesthesia, epilepsy, paraplegia, amaurosis, etc., have been observed to result from alcoholic excess, and mental alienation, as the asylum statistics prove, has in the same agent its most influential cause.

It is necessary now to consider what becomes of the alcohol after its introduction into the human body, and the influence which it exerts, if any, in the metamorphosis of tissue. The results of experiment on these points have been remarkably contradictory; and the questions involved are by no means settled. It would require a volume to make a satisfactory analysis of the various memoirs and papers which have been published on the actions of alcohol. The author, therefore, merely presents the conclusions to which he himself has come, after a careful consideration of all the more important contributions to the literature of the subject.

A small quantity of alcohol, in a subject not accustomed to its use, causes, as has been already stated, increased activity in all the bodily functions, and slight elevation of temperature. Habit, as is the case with a great many drugs, modifies in a remarkable manner the physiological activity of alcohol, and hence these results are not perceived in the habitual consumers of this substance. Considerable doses of alcohol cause a decline in the temperature of the body, which is even more marked in pyrexia than in the normal state. As respects this effect, the influence of habit is equally great, for in old topers a decline in temperature does not follow the use of alcohol in doses short of lethal. In animals the reduction of the body-heat is more marked than in man. To what cause is the decline in temperature, produced by alcohol, attributable? This is, doubtless, referable to the diminished rate of tissue metamorphosis—for it has been ascertained that the excretion both of urea and of carbonic acid is lessened by alcohol. The combustion of the nitrogen and carbon foods is, therefore, retarded. This action is represented, objectively, by an increase in the body-weight and the embonpoint of those who take stimulants moderately.

The disposition of alcohol in the organism is a subject which has gone through several revolutions of opinion. At present the weight of authority and the deductions of experiment are in favor of that view which maintains that, within certain limits (one ounce to one and a half ounce of absolute alcohol to a healthy man), alcohol is oxidized and destroyed in the organism, and yields up force which is applied as nervous, muscular, and gland force. The amount of alcohol ingested, in excess of this oxidizing power of the organism, is eliminated as alcohol by the various channels of excretion—by the lungs, skin, kidneys, etc. As alcohol checks tissue metamorphosis, and thus diminishes the evolution of heat and force, it might be expected that the products of its own oxidation would supply the deficiency, but this is not the case. Alcohol is a useful food in the small quantity which increases but does not impair digestion, which quickens the circulation and gland secretion but does not over-stimulate, and which is within the limit of the power of the organism to dispose of by the oxidation processes. This amount has been pretty accurately shown, as stated above, to be one ounce to one ounce and a half of absolute alcohol for a healthy adult in twenty-four hours. All excess is injurious. North-pole voyages, military expeditions (experiences in India and the Ashantee march), and the diminished power of resistance to cold shown by drunkards, have conclusively demonstrated that alcohol does not supply the place of other foods; and that those habituated to its use, damaged as they are in their vital organs, do not possess the same endurance of fatigue and the same power of resistance to external morbific influences as do the healthy. Furthermore, clinical experience has amply proved that topers do not bear chloroform well, that they succumb more quickly to injuries and surgical operations, and that they possess much less power of resistance than the temperate to the inroads of acute diseases. While these facts rest upon the soundest basis, it is equally true that alcohol is, within certain limits, a food, and that the organism may subsist, for a variable period, on it exclusively.

It is an important clinical fact that the physiological effects of alcohol differ in different conditions of the system. In convalescence from acute diseases, in the sudden depression of the powers of life caused by the bites of venomous snakes, or from loss of blood, or from serious injury, quantities which would, in the state of health, cause profound intoxication, are taken with impunity. The extremes of life—infancy and old age—bear considerable quantities of alcohol well, and are often remarkably benefited by them. Habitual use modifies still more decidedly the immediate influence of this agent on the functions of calorification, of circulation, and of the nervous system.

The differential diagnosis of acute alcoholism (lethal dose), of opium narcosis, concussion of the brain, cerebral haemorrhage, and haemorrhage into the pons or medulla, is by no means easy. In the absence of the history, in any given case, it may be impossible to determine. The odor of the breath (of opium or alcohol); the state of the pupil (contracted from opium, unequal, or contracted or dilated from intracranial haemorrhage, contracted or dilated from alcoholic intoxication); the muscular resolution (common to all these states); the slow, sighing, irregular, or stertorous respiration (may occur in either); the abolition of reflex movements (a final symptom in all), are in the nature of things fallacious. A man who has received a concussion of the brain, or had an intra-cranial haemorrhage, may have taken opium or alcoholic stimulants in quantity sufficient to impart a distinct odor to his breath, without otherwise being distinctly affected by it. The other signs are not sufficient in themselves to enable a decision to be reached. Hence the importance of an attentive examination of the surrounding circumstances. In the absence of a trustworthy history, it were better to suspend opinion until the further developments of the case enable an exact diagnosis to be made. The numerous examples of errors fallen into by most competent observers should make the physician hesitate before pronouncing an opinion of "drunk" or "dying," in the sensational language by which some of these cases of mistake have been characterized.

The treatment of acute alcoholism consists in the evacuation of the stomach by the stomach-pump of any unabsorbed alcohol; the cautious inhalation of ammoniacal gas; cold affusion to the head; faradism of the muscles of respiration, external warmth, etc.

As respects the post-mortem appearances the following have been observed: intense hyperaemia of the gastric mucous membrane; distention of the right cavities of the heart, and of the great venous trunks; hyperaemia of the cerebral meninges, and serous effusion into the ventricles and subarachnoid spaces.