The term drunkenness is here used to designate the nervous and mental symptoms by which acute alcoholic intoxication manifests itself.

The predisposition to the state of drunkenness, quite variable in different subjects, is a part of the general tendency of the individual toward nervous and mental disorders: "It may be truly said that alcohol is the touchstone of the equilibrium of the cerebral functions." 1

We have had under observation an imbecile whom a single glass of wine sufficed to make drunk.

Drunkenness is somewhat schematically divided into two stages: (1) excitement, and (2) paralysis. In reality nevropathique. Paris. F. Alcan. - This statement is correct, everything else being equal. But it must be borne in mind that there are other factors, besides mental instability, that have to do with an individual's susceptibility to alcohol. Age is one such factor, young persons being more susceptible than middle aged or old ones. But by far the most important-factor is habit. We know well that it is not uncommon for morphine addicts, who have gradually acquired a tolerance for that drug, to take as much as twenty grains at a dose with no other than a mild euphoric effect, whereas one-fortieth of this dose produces profound sleep in an ordinary person, and one-fourth may readily prove fatal. We know also that the same kind of tolerance can be acquired for arsenic and for many other poisons, and, in fact, we often utilize this very principle in the artificial production of immunity against certain micro-bic toxines, such as those of diphtheria and tetanus.

It is undoubtedly so also in the case of alcohol, for it is on the basis of such an acquired tolerance that chronic alcoholics often boast of being able to "stand any amount" or at least of being "always able to navigate." paralysis is present from the beginning, but in the first stage it is limited to the higher psychic functions and is masked by the intensity of the automatic phenomena, so that it does not become evident until the second stage, when all the nervous and mental functions become involved in the paralysis.

1 Fer6. La Famille

First Stage: Excitement

Psychic inhibition, the first manifestation of the paralysis, is seen in the slow association of ideas, distractibility, and insufficiency of perception.1 The automatism is apparent from the disconnected conversation, which may show true flight of ideas, abnormal pressure of activity, more or less marked morbid euphoria and irritability, impulsive character of reactions, and extremely voluble speech. The moral sense and regard for common conventionalities gradually disappear, and the patient may commit ridiculous, repugnant, offensive, or even criminal acts.

Second Stage: Paralysis

Paralysis, confined in the preceding stage to the sphere of the higher psychic functions, now attacks the automatic functions. The movements are awkward and clumsy, speech indistinct, gait unsteady. Gradually the patient falls into a profound, sometimes comatose, sleep - the final stage - from which he awakes lucid but with a confused recollection of what has passed and with a pronounced sensation of mental and physical fatigue.

Such is, rapidly sketched, the aspect of common drunkenness. From the accentuation or obliteration of certain features result the diverse abnormal or pathological forms.

Comatose Drunkenness

The phenomena of excitement are either absent or very transient. From the beginning the paralysis affects the entire brain. The patient sinks and remains inert and insensible for several hours. His face is congested. Gradually the comatose state is replaced by sleep, from which the patient awakes without any recollection whatever of the occurrences immediately preceding his intoxication. Sometimes the pulse becomes small, the heart weak, the breathing labored, and in some cases, which are fortunately rare, the patient dies in collapse.

1 Rudin. Auffassung und Merkfahigkeit unter Alkoholwirkung. Kraepelins Psycholog. Arbeiten, Vol. IV, No. 3.

Maniacal Drunkenness

Here paralysis occupies a secondary position and excitement dominates the scene. The phenomena of agitation generally develop very rapidly. All of a sudden the drunkard, while still at the saloonkeeper's bar, is seized with an outbreak of furious madness without any apparent cause or provocation; he breaks objects and furniture, becomes noisy, and threatens and attacks those about him. The extreme clouding of consciousness shows that, in spite of appearances, "psychic activity takes but a very small part in the production of the outbreak," and that "subjugated by this automatic development of psycho-motor activity it disappears entirely." l Almost always numerous psycho-sensory disorders (hallucinations and illusions) are associated with the clouding of consciousness and excitement.

The attack terminates in profound sleep. This, as in the preceding form, is followed by almost complete amnesia.

Convulsive Drunkenness

The maniacal form of drunkenness resembles closely the delirious attacks of epilepsy. The relation between epilepsy and acute alcoholic intoxication appears still closer when we consider that drunkenness may clinically assume the aspect of an epileptic seizure. This is explained by the convulsive properties of alcohol, which have been demonstrated experimentally. Attacks precisely like those of essential epilepsy may supervene in the course of common drunkenness. In all cases they immediately follow the alcoholic excesses, differing in this respect from those epileptiform seizures which supervene in the course of chronic alcoholism.

Delusional Drunkenness

This curious but rare form has been studied by Gamier. The delusions are extremely variable: ideas of persecution, ambitious ideas, depressive ideas with suicidal tendencies, etc. Delusional drunkenness is encountered only in profoundly neuropathic individuals.

Gamier. La folie a Paris.

Pathological Anatomy

The lesions of acute alcoholic intoxication have been studied chiefly in animals poisoned experimentally. Macroscopically there are congestion and sub-pial hemorrhages. Microscopically are found, in addition to engorgement and distention of the blood-vessels, nerve-cell changes consisting principally in swelling of the nuclei and peripheral chromatolysis. These lesions are most marked in the motor cells of the spinal cord, but they exist also, though less pronounced, in the cells of the cortex.1

Treatment

This of course varies with the different forms. Maniacal or delusional drunkenness requires strict watching and immediate isolation; the comatose form requires the use of external and internal stimulation (friction, ammonium, ether, caffein).

1 Marinesco. Semaine meclicale, June 14, 1899.