A third mode of poisoning is by the superinduction of inflammation of the brain or its meninges. This condition is either left behind after the disappearance of the coma, or the symptoms of the two conditions are commingled. Whenever, with more or less stupor, there are delirium, convulsions, tonic contraction of the flexor muscles, and local or partial palsy, the existence of the inflammatory complication may be considered as pretty certain. This condition of things, however, is more apt to accrue from a continued debauch of several days, or weeks, than from one hard drinking spell, unless there may have been a predisposition to the affection. It is a very dangerous condition, and many die of it; often sinking into a state resembling typhoid fever before death.

Still another mode of poisoning is by acute inflammation of the stomach and bowels. Gastritis, in a greater or less degree, I have frequently witnessed, in the Pennsylvania Hospital, among patients brought in while labouring under the effects of strong drink. But it is very seldom fatal. Instances, however, are on record, in which this seems to have been the immediate cause of death.

The accidental deaths resulting, in the coma of drunkenness, from ex- posure to cold, from drowning, or from various kinds of violence, as when the body is run over by a locomotive on railroads, do not properly fall into this category; though they are useful warnings, and may be appropriately enumerated in the list of evils consequent upon this terrible vice.

Chronic Poisoning. A great diversity of evils arise from the habitual use of alcoholic drinks. I shall treat of them in the order of their successive occurrence.

1. The stimulant influence of alcohol renders the system at all times more liable to inflammatory attacks from ordinary causes, especially in the earlier stages of its habitual use, or in those persons who employ it in such a manner as not materially to impair the energies of their system. It has this effect, first, by inducing a plethoric state of the blood, which predisposes to inflammation, and, secondly, by stimulating the circulation, and thereby acting as an exciting cause when a predisposition already exists, or aiding other irritant influences.

2. Conjointly with the use of rich food and stimulating condiments, it contributes to the development of gout. In persons predisposed to this disease from inheritance, it hastens its appearance; and, in those not predisposed, it is quite sufficient, in conjunction with the other agencies mentioned, to originate the diathesis. But, of those who abuse alcoholic liquors, only a comparatively small number are attacked with gout. This demands explanation. The origination of the gouty diathesis requires the co-operation of causes which, without materially impairing the vital forces, shall produce and sustain an habitual state of plethora and excitement. In great excess, alcoholic drinks rapidly wear out the excitability of the system, and induce an indirect debility, which leads to various other disorders, but is incompatible with the generation of the gouty constitution. More moderately used, however, and with rich food, they stimulate the blood-making functions, without so rapid an exhaustion of the excitability. A greater amount of food, therefore, is converted into blood than without the aid of the stimulant, and a state of plethora is produced, which the continuance of the same habit sustains. The abuse, consequently, of wines and malt liquors is more apt to cause gout than that of ardent spirits; and hence the prevalence of this disease among the rich and luxurious. But the amount of exercise taken has also much influence over the result of alcoholic stimulation. By vigorous exercise the plethora induced by wine-drinking and a rich diet is repressed, the excess of blood is consumed by the excess of the excited functions, and the equilibrium of health is preserved. Hence, a person of somewhat luxurious habits of eating and drinking may counteract their effects by proportionally vigorous exercise. It is from a conjunction of the moderately luxurious with sedentary habits that we are to look for the development of gout. Again, an excess in the use of alcohol which would soon indirectly wear out the powers of a sedentary man, if counterbalanced by violent bodily exertion, may tend to sustain the system at a point of elevation favourable to this disease. An individual may become intoxicated at his table every evening, and yet, if he spend all the morning in some active exercise, as on horseback in the chase, may ward off the prostrating influences of the poison, and escape with only the penalty of gout. It is not so much, therefore, the particular quality of the liquor drank, whether it be wine, or whether rum, which determines the occurrence of gout preferably to general debility, as it is the quantity of the stimulus used, and the other attendant circumstances.

3. Another evil arising from the abuse of alcohol is the direct production of inflammation in the organs upon which its stimulant agency is most strongly exerted. Sometimes this inflammation is acute; but much more frequently it is chronic, and the necessary result of a long-sustained irritation. The organs upon which alcohol especially expends its force are the stomach, the brain, and, secondarily, the lungs and the liver. These, therefore, are most frequently affected; but the bowels, kidneys, heart, and arteries sometimes participate in the disease. Evidence of this is exhibited not only by the symptoms during life, but by the appearances upon dissection. Every physician is familiar with the chronic gastritis of drunkards. Inflammation of the brain or its membranes is scarcely less common, though, in the acute state, often confounded with delirium tremens, and, in the chronic, masked by the disorder in the cerebral functions incident to habitual intoxication. Reference is often made, in the records of insane asylums, to intemperance as one of the causes of insanity. There are some persons who always have an attack of this disease, when they indulge in the use of alcoholic drinks. The duty is devolved upon the lungs, partly at least, to throw off, in the form of vapour, the portion of alcohol not expended in the nutritive process. Hence, bronchitis is a common disease of drunkards; and other pectoral inflammations are not unfrequent. The liver is another of the emunctories through which the superfluous alcohol is thrown off, probably in the form of fatty matter. This organ, therefore, is kept constantly in a state of undue excitation, and, as a result, is not unfrequently inflamed. Disease of the liver is among the most common complaints of habitual drunkards; and though, as will be seen directly, it is not exclusively inflammation that occurs, yet this does take place in a considerable proportion of cases. Out of seventy-three cases of drunkards examined after death by Dr. F. Ogston, of Aberdeen, Scotland, the liver was found generally hypertrophied in nine, and partially in two cases; and, though this hypertrophy may possibly have been in some instances the pure effect of a sustained over-excitement, yet much more probably there was in all an admixture at least of inflammation during life. It is not necessary to refer more particularly to the other organs mentioned. In all of them lesions are frequently found, which may be best explained by the supposition of the previous existence of chronic inflammation.