4. From the constant stimulation of the whole system, and especially of the brain, the excitability is so far exhausted that, on the withdrawal of the stimulus, a condition of extreme prostration takes place, which often ends fatally, unless counteracted. The brain, left without its ha-bitual support, exhibits its suffering in a peculiar kind of delirium, called delirium tremens or mania a potu, the characteristics of which are singular hallucinations, the fear of some present or impending evil, sleeplessness, and muscular tremors. This has been considered by some as inflammation of the brain. But, in its pure form, it has nothing to do with inflammation. It is the simple result of the withdrawal of the alcoholic stimulus, and is a condition of real depression in the cerebral centres, showing itself by the irregularities referred to. It is, moreover, relieved by restoring the stimulant impression by means of alcoholic drinks or opium. In the Pennsylvania Hospital, I have had frequent opportunities of watching the attack and removal of this affection. I have, in numerous instances, seen it coming on more or less completely when the wonted stimulus has been withheld, and have almost as constantly seen it yield to a renewal of the stimulus. It will be observed that I am now speaking of pure delirium tremens. But there are often mixed cases of a very different character. In these, some inflammatory and febrile attack has rendered the patient careless of the stimulant, or averse to it. The cerebral centres, left unsupported, fall into the abnormal state under consideration, and there is now a mixture of local inflammation with delirium tremens. Not unfrequently the inflammation is the direct result of the alcoholic stimulus. The patient, goaded by his insatiable thirst for the poison, gives himself up for a period to the most frantic indulgence, until he is at length brought up by an attack of inflammation of the brain or the stomach, the direct result of the excessive quantity of alcohol taken. Then the debauch ends, and, the drink being suspended, delirium tremens along with the meningitis or gastritis seizes on its victim. These attacks, unless promptly and efficiently treated, especially the meningeal cases, are very apt to terminate fatally, and sometimes do so even under judicious treatment; while the simple delirium tremens, which constitutes the vast majority of cases, is curable almost certainly, if the patient be prevented from sinking into a fatal prostration from the want of support.

But it is not only upon the withdrawal of the wonted stimulus that the effects of depressed function are experienced. With the constant repetition of the excitement, there is as constant a diminution of the excitability, so that the stimulated functions can be sustained only by a steady increase in the quantity of the stimulus, until the time at last comes when no quantity that can be taken is sufficient to support the working of the exhausted organs. It is surprising how much ardent spirit the system can be brought to bear. Two or three pints of raw spirit are consumed daily by some confirmed rum-drinkers. But, as just stated, even should no organic mischief happen in the mean time, the functions must at last fail. In relation to the stomach, dyspepsia; to the bowels, constipation ; to the liver, insufficient secretion, are ordinary results. The circulatory and respiratory functions are also enfeebled ; the generative function is impaired; and even nutrition, at first over-stimulated, now fails, and the patient becomes either emaciated, or pale and bloated. The cerebral functions also suffer greatly. The intellect is enfeebled, the power of self-command is lost, and the predominant propensities or passions, whatever they may happen to be, are scarcely resisted. The influence of the will over the muscles is greatly impaired, and the patient is subject to habitual tremors when not under the fullest action of the stimulus. These tremors sometimes deepen into positive paralysis, though there is reason to think that, by this time, the brain has become organically deranged.

5. The last stage of physical degradation is now reached. The failure of the functions both organic and nervous leads inevitably to degenerate organization. The blood is depraved, nutrition suffers, and different parts of the frame undergo various degradation; those being most affected the functions of which have been previously most stimulated, and consequently most exhausted. In many instances, the vital forces have been so prostrated, in particular organs, that chemical influences predominate, and the tissue is converted more or less into oil. This, is the fatty degeneration. In other instances, the disorganization is less complete; and abnormal tissues bearing some resemblance to the fibrous, cartilaginous, or bony, take the place of the healthy structure. The brain, the stomach, the liver, the kidneys, and the heart and blood-vessels are peculiarly the seats of this organic degradation; and their great vital functions suffer accordingly. The most diversified forms of functional or organic disease are presented in different cases, most of them tending to a dropsical condition, in which the patient is at last apt to perish, if he has escaped the numerous dangers which have beset him almost from the beginning, and which cause vast numbers to be carried to a premature grave. The cirrhosed or fatty liver, the granulated kidney, the hypertrophied or dilated heart with its various valvular disease, the ossified blood-vessels, and the depraved blood, deficient in red corpuscles, but abounding in oil and carbon, are the most frequent causes of the dropsy.

Dr. Magnus Huss, Professor of Clinical Medicine in Stockholm, has described a paralytic affection, which he denominates alcoholismus chronicus, and which he ascribes solely to the poisonous influence of alcohol. It is very common in Sweden, where intemperance is said to prevail to a fearful extent. The affection shows itself first in tremors and unsteadiness of the voluntary muscles, usually commencing in the upper extremities, then extending to the lower, and at length involving the muscles of the trunk. The trembling is often violent, particularly on the occasion of any voluntary effort, and is greatest in the mornings before the patient has had recourse to his accustomed stimulus. Sensation after a time begins to be affected; formication occurs here and there; and at last both sensation and the power of motion are lost over a greater or less extent of the body, the special senses being not unfrequently involved. Instead of this paralytic condition, the poisoning may assume the spasmodic or convulsive character, marked at first by twitchings, and afterwards various irregular muscular contractions, terminating in positive epileptic paroxysms. All these phenomena are readily explicable. The first failure of muscular power is probably the result of mere exhausted function in the brain; but the more serious subsequent results must be ascribed to the organic changes which have, in the mean time, been going on in the cerebral tissue.

6. Another and not the least evil of the abuse of alcoholic liquors, is the increased danger given by it to other diseases; partly through the impaired state of the constitution, which renders it less able to resist them; partly through the impossibility, under which it places the physician, of using that energy in the treatment which the diseases may require; and, in some degree also, in consequence of the relative inertness of alcoholic remedies in the intemperate, in whom they are most needed.

I have purposely avoided the consideration of the moral aspect of intemperance, which, even if we confine our views to this world, presents an amount of evil, far exceeding the physical, terrible as this must be acknowledged to be.